Network Transparency is all about making sure consumers have the information they need, both when shopping for a health insurance plan and when putting that plan to use. Health insurance networks are made up of many different contracts between healthcare providers, such as doctors or facilities, and the insurance company. The department wants to ensure that consumers have access to their network information.
Why is Network Transparency Important?
- Directories must be updated once the insurance company is made aware of a change in the status of a provider or facility.
- Directories must not require a login or member ID number for access. Paper copies of the directory shall be made available upon request.
- Network names should be easily identifiable and remain consistent across publications and webpages provided by the insurance company.
- Directories must include certain information for each in-network provider, such as name, gender, specialty, status of accepting new patients, languages spoken, office locations and various affiliations and certifications.
- Upon termination of a provider from the network, the insurance company must provide notice to any enrollee who has received services from the provider within the previous 12 months.
- The directory must be updated before an insurer can charge additional, out-of-network costs to a consumer.
What Can I Do To Protect Myself?
- Contact your insurance company to verify that the directory information you saw regarding your network is correct.
- Document the exact time the phone call took place and ask for the name of the person you spoke with . When searching online, be sure to screenshot or print the information you see.
- When verifying the network status of your provider, be sure to specify the location at which you will be receiving services, particularly if your provider practices at multiple locations.
- When checking in at the provider or facility, provide your most recent insurance information or verify that what is on file in the office is up-to-date.
- Should your doctor or hospital visit require lab or pathology reports, confirm that those facilities are also in your network