ISMS Seeks Members’ Input on the Adequacy of Provider Networks

March 11, 2022

ISMS Seeks Members’ Input on the Adequacy of Provider Networks

ISMS has been hearing from some members who are concerned that commercial health insurers are significantly reducing patient options for medical care by offering inadequate networks – against Illinois law.

We’d like to hear more about this issue from all of you. Are you having trouble when referring your patients for specialty care because of the reduced availability of healthcare professionals in a given network? Here are some points to consider:

  • When you refer your patients to specialists, are your patients facing higher costs, longer wait times or increased travel times due to a lack of in-network physicians nearby?

  • Are you running into insurance-prepared directories that show physicians who are unavailable, not taking new patients, are located far away or who don’t work at the listed medical facility – known as “ghost networks”?

  • Are patients who suffer from severe medical conditions or who are in their third trimester provided continuity of care or are they forced to scramble in the middle of their treatment to find alternative healthcare professionals?

  • Have you or any of your colleagues been dropped from a network?

Please share your comments with ISMS via email by Friday, March 25, 2022.


In 2017, ISMS fought long and hard to help enact the Network Adequacy and Transparency Act (NAT Act) – our top legislative priority at that time. Patients purchasing state-regulated private health plans were increasingly experiencing sudden reductions in their provider networks without any notice beforehand.

The NAT Act was enacted to not only ensure Illinois patients will have the information they need to make the right choice about the health insurance they're purchasing, but to also make sure they will receive the coverage as promised. The NAT Act provisions began to apply to plans issued in 2019.

Here is a summary of the protections guaranteed under this law:

  1. Insurance companies must ensure their networks meet patients' needs. That means insurance plan networks must have enough health facilities and doctors, including specialists, in close proximity to where their policyholders live.

  2. Health plans must be more transparent. Insurers are obligated to maintain updated provider directories. If a doctor or hospital is dropped from a network, the insurance company must notify patients in a timely fashion. Doctors also face new patient notification requirements if they choose to leave a network.

  3. A patient's doctor may be dropped from the network, but pregnant women and patients with complex conditions will be able to stay with their doctors long enough to make a smooth transition – without getting charged extra. 

If you have questions about the NAT ACT, please contact ISMS Senior Vice President of State Legislative Affairs Erin O'Brien by email.

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