American Society of Plastic Surgeons
For Consumers

Ohio and Rhode Island: Enact Stronger Network Adequacy Requirements

The Ohio Department of Insurance and the Rhode Island Office of the Health Insurance Commissioner, respectively, released network adequacy proposals regarding provider directories published by the insurance carriers. While both state proposals are well-intended, both lacked clear accountability requirements for insurance carriers if those directories were inaccurate and/or misleading.

To ensure that patients have in-network access to necessary specialty care providers and to deter insurance carriers from shirking their notification duties, ASPS requested amendments to the proposals that require carrier accountability for inaccurate directories. In the event that services are delivered by an out-of-network due to an inaccurate or outdated directory, the Society requested that the carrier reimburse the provider at the provider's billed amount.

We await a final rule from the Ohio Department of Insurance and Rhode Island Office of the Health Insurance Commissioner.