Network Adequacy

networkadequacy

When consumers enroll in a health insurance plan, they gain access to a network of medical providers. Insurance companies contract with a range of providers, including both primary care and specialty physicians, to deliver health care services included within the plan’s benefit package. This network of providers must be adequate to ensure that consumers enrolled in the plan have reasonable access to all covered benefits. This is what is meant by network adequacy. 

 

Are newly insured Georgians accessing the care they need? For the most part, the answer seems to be yes, but there are also some warning signs on the horizon. As narrow provider networks become more common, health care consumers need accurate and more usable information about the size and composition of provider networks to make meaningful choices about health insurance. In addition to transparency measures like enhancements to provider directories, Georgians for a Healthy Future also supports updating Georgia's network adequacy laws and regulations to ensure that consumers can access a provider in their network for all covered benefits. 

 

Learn more about our advocacy around network adequacy and provider directories through the resources and information on this page. 

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#TGIF: Thinking about how much you need a mental break this weekend? We’re thinking about how much the #ACA does for mental health!

The ACA provided one of the largest expansions of mental health and substance use disorder coverage in a generation because, for the first time, small employer and individual insurance plans are required to treat mental health care as equal to general medical care. On top of that, coverage for mental health and substance use disorder is considered part of the ACA’s essential health benefits, meaning behavioral health services must be covered by insurers in the same way physical health services would be covered, no matter what kind of coverage you have.

There’s more! Many of the popular provisions of the ACA are extra beneficial for people with behavioral health needs:
- Some mental health and substance use screenings for adults and behavioral assessments for children are considered preventive services now, meaning they are covered with no out-of-pocket costs.
- Because people can no longer be discriminated against for pre-existing conditions, many have been able to seek the treatment and supports that they need without worrying that getting care will disqualify them from the insurance coverage later.
- Mental and behavioral health conditions can be triggered or exacerbated during stressful times of transitions, like the change from high school to college, or school to career. Being able to keep young adults on a parent’s plan through age 26 allows young people with behavioral health needs to maintain their coverage during times when they most need the support. ow.ly/d/5X01
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The debate over the future of the #ACA is well-reported but new on the health care debate stage are proposals to drastically cut Medicaid, which provides health insurance to the most vulnerable people in Georgia. Remember that GHF has you covered with the information and facts you need to fact check the Medicaid myths that you will hear in the debates over the program and the proposed cuts. A couple examples:

-Medicaid plays a critical role in Georgia’s health care system, especially for our state’s most vulnerable populations. 64% of Georgia’s Medicaid recipients are low-income children. Medicaid also covers our low-income seniors, people with disabilities, pregnant women, and uninsured women with breast and cervical cancer.
-Medicaid bestows long-term positive effects on kids with coverage through the program. ow.ly/OzOT309e9G2
-Medicaid is a highly efficient program spending $0.94 of every dollar directly on health services.
-People with Medicaid coverage have access to health care when they need it and financial protection from unexpected medical costs, just like people with private insurance.

Check out GHF and GBPI’s Medicaid chart book to get to know Georgia’s Medicaid program a little better: ow.ly/uMge309e4LK
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GHF In The News
Mar 9, 2016
Bill aims to erase errors in insurers’ medical directories
Andy Miller

"Directory errors can be common. For example, a “secret shopper’’ survey done by Georgians for a Healthy Future found numerous errors in four “silver-level” HMOs in Atlanta that the consumer…

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