NCMS Joins Others to Urge Meaningful Standards for Network Adequacy

The North Carolina Medical Society (NCMS), along with more than 110 other medical and patient groups nationwide, recently joined together to urge the National Association of Insurance Commissioners (NAIC) to adopt meaningful standards as it revises its model act on network adequacy.  The letter outlines six key issues that must be addressed in the final model act.

NCMS CEO Robert W. Seligson, in his role as the President of the Physicians Advocacy Institute, Inc. (PAI), has been working closely with the NAIC to revise its Network Adequacy Model Act.

The adequacy of provider networks marketed by health insurance carriers, particularly those networks established for health plan products within health insurance exchanges, is of growing concern to physicians and patients alike. State and federal regulators are responding with efforts to enhance regulatory scrutiny as insurers significantly revise networks including eliminating physician contracts to create “narrow” networks – to contain costs.

The revised Model Act will provide a template for states as they work to ensure that health insurers offer provider networks that afford beneficiaries sufficient access to health care providers and the full range of their covered health plan benefits.


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