Maine panel explores regulating ‘narrow band’ insurance networks

0

AUGUSTA — A legislative panel is working on how Maine might regulate so-called “narrow band” networks offered by health insurance providers.

The Insurance and Financial Services Committee on Thursday again tabled a pair of bills that seek to improve disclosure for patients and health care providers and to determine limits for how far a patient must travel for health care.

So far, the committee has taken a look at what other states do and what Maine’s current law allows.

The new insurance plans, allowed under the federal Affordable Care Act, can limit where subscribers can seek treatment and from whom.

Advertisement

While several lawmakers appear poised to support some kind of change to Maine law, others said the federal ACA, which would supersede state law, remains a “moving target.”

The panel’s Senate chairman, Geoffrey Gratwick, D-Bangor, who is a doctor, said he wanted the law to ensure patients would get the best care available, especially for unique conditions. But he said he understood that allowing patients to seek care for any condition without restraint would be unreasonable. He said patients ought to be allowed to see specialists for rare or difficult-to-treat cases.

“But I think there should be a chain by which you can refer people,” Gratwick said. “I want that person to be able to get the very best care they can, but it needs to be so we are not just talking about treatment for a sore shoulder or the snuffles.”

Before the panel are bills that would require disclosure to health insurance customers — before they buy plans — to clearly show them which providers will be in their networks and which won’t.

The measure also allows health care providers such as hospitals to find out why they were excluded from a particular health insurance provider’s network. Other lawmakers suggested an appeal of exclusion also be allowed. 

Legislators want to ensure “narrow network” plans — those that limit which health care providers a subscriber can use — disclose that up front. They want a so-called “black box” disclosure that would clearly show a health insurance customer which providers are in the network.

Maine is one of 27 states that chose not to set up its own exchange and instead depends on one operated by the federal government under the ACA.

While Maine already has a law that sets standards for health care networks, that law is not as specific as the laws in some other states. 

One concern from health insurance providers is that more disclosure could lead to the release of sensitive “proprietary” information that could put businesses at a competitive disadvantage. But several other states, including Montana, already have similar disclosure laws on the books.

The panel also mulled over whether it could merge the bills into one for final consideration. One of the bills, LD 1629, looks to address the disclosure issues, while the other, LD 1676, is aimed at expanding access to health care providers with so-called “any willing provider” provisions.

The committee will take up the bills again when it meets Feb. 18.

sthistle@sunjournal.com

Advertisement
SHARE