Evaluation of health plan network sufficiency. (FE)
Impact
Should AB792 be enacted, it would introduce a formal evaluation process for health plans in Wisconsin regarding their network sufficiency. This could significantly enhance the quality of health coverage for residents by ensuring that their insurance plans provide reasonable access to healthcare services. The impact would be particularly notable in rural areas, where provider scarcity is a common issue. The bill also allows the commissioner to require health plans to make accommodations for enrollees when their network is lacking, which could lead to improved health outcomes and patient satisfaction.
Summary
Assembly Bill 792 aims to evaluate the sufficiency of health plan networks, specifically defined network plans and preferred provider plans, which are essential types of managed care organizations offering health care benefits. The bill mandates that the commissioner of insurance assesses whether all covered services are accessible to enrollees without unreasonable travel or delays. It emphasizes the importance of ensuring that enrollees have adequate access to medical providers and services, addressing a potential gap in patient care that can arise from insufficient network coverage.
Contention
Despite the potential benefits, the bill may spark debate among stakeholders. Providers and insurance companies may express concerns about the additional regulations and requirements imposed on them, suggesting that these could lead to increased operational costs or restrict their business models. Furthermore, there may be discussions around the criteria used to determine network sufficiency, as different stakeholders could have varying opinions on what constitutes 'unreasonable' travel or wait times. This could lead to pushback from those worried about the regulatory burden on health plans.