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May 2016
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  • Patients Need to Know What's Inside the Insurance They Buy
    Thomas M. Anderson, MD
    ISMS President
    Thomas M. Anderson, MD

    Just four days after I was sworn in as your new ISMS president, I found myself speaking at a news conference in Springfield. It was my pleasure to be the voice of physicians in support of the Network Adequacy and Transparency Act (House Bill 6562), legislation to protect patients from unacceptable insurance practices.

    As I’m sure you are aware, over the past year commercial health insurers have accelerated their efforts to “downsize” PPO networks by severely limiting the number of in-network health professionals available to patients.

    These “narrow networks” force patients to scramble in search of new – and often unfamiliar – “in-network” physicians for their care, cutting off the vital physician-patient relationship.

    Not only is their care disrupted, many patients face sticker shock when they lay eyes on their new bill for care that was previously in-network.

    The impact of reduced network options is significant. Imagine a pregnant woman having to find another OB/GYN mid-pregnancy, or a cancer patient fighting for life suddenly learning that his or her trusted physician is no longer an affordable option.

    Unfortunately, some people don’t have to use their imagination.

    Click here to read about a patient who had been seeing specialists at the University of Chicago to treat her autoimmune disease. At an early January visit, just a few weeks after she purchased a Land of Lincoln PPO plan for 2016, she learned that her insurer would be dropping the medical center and its doctors from the network she chose, effective March 1. Of course, by March 1 open enrollment had already closed, leaving her without the option to change her plan.

    Witnessing the confusion and disruption our patients experience is immensely frustrating for doctors.

    The good news is that we’ve identified a remedy: the bi-partisan, ISMS-backed House Bill 6562. Here’s why we are excited about it.

    This legislation would require insurers to demonstrate that their plans have an adequate ratio of health professionals to patients, and that patients can access care close to home. Otherwise, the plan couldn’t be sold to consumers. Patients with certain medical conditions and pregnant women would be allowed to continue care with their doctor as “in-network,” even when plan options change. What’s more, all patients would be allowed to reconsider their coverage when a plan removes their doctor from the network outside of the open enrollment window.

    The bill also requires insurers to maintain accurate and up-to-date network directories of doctors and hospitals so that patients can make well-informed decisions when selecting health insurance plans.

    ISMS is aggressively working to enact House Bill 6562.

    At the end of the day, we cannot allow our patients to live in fear that their chosen physician or hospital might abruptly become an unaffordable choice, or that the network they signed up for might change without warning.

    The patients of Illinois deserve to know what they're getting when they buy health insurance.

    I look forward to hearing from you. During my term, I can be reached at DrAnderson@isms.org.

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