Debbie Smith of Jupiter says she is battling cancer so she really cannot afford the unpleasant surprises she has faced this year concerning which doctors are in her health plan’s network — and she wonders if insurers have any obligations to keep their provider lists updated.
“This is shameful on the industry,” Smith said. “You’re talking about people’s lives.”
Yes, federal officials said when The Palm Beach Post asked about a question she raised — an insurer’s provider directory is supposed to be updated no less than once a month.
“While changes are typical between a health plan and their network, there are specific regulations and communication requirements to make sure enrollees have access to benefits,” said a statement provided by the U.S. Department of Health & Human Services. “We work with states to make sure health plans are fully compliant with the rules and regulations.”
Federal officials did not address a question on penalties, but said they are working to further strengthen network adequacy requirements.
Beginning in 2017, U.S. officials “will require the issuer to provide written notice to all enrollees who are patients seen on a regular basis by the provider or receive primary care from the provider of discontinuation of a provider 30 days prior to the effective date of the change or otherwise as soon as practicable.”
In cases where a provider is terminated without cause, officials “will require issuers to allow enrollees in active treatment to continue treatment until the treatment is complete or for 90 days (whichever is shorter) at in-network cost-sharing rates.”
As The Post reported, consumers say they checked on which doctors were in network for Florida Blue, or Blue Cross and Blue Shield of Florida, before signing up for 2016 Obamacare coverage — only to find those doctors were not necessarily in the plan in the early months of the year.
Company officials have apologized and said they are working hard to solve these problems in Palm Beach County, among other places.
Smith said these are not minor issues for people with conditions like cancer.
“Beside the fact I want to cry and punch the wall, I’m petrified,” Smith said.