Patients in Illinois are facing a health care crisis that deserves more attention because it affects the availability of medical care in communities across the state. Have you ever been unable to schedule an appointment because a practice doesn't accept your insurance, or because the specialist you wanted to see no longer worked there? You were probably surprised because you had verified that information online on your health insurance company's directory before contacting the physician's practice.
The reality is that too many insurance companies do not keep their provider directories up to date. The 2017 Network Adequacy and Transparency Act (NAT Act), a state law backed by the Illinois State Medical Society, sought to address this issue by mandating that state-regulated insurance companies maintain an adequate network of health care professionals, to ensure that patients have access to the doctors and the care they need. Under the NAT Act, insurance companies are also required to keep their provider directories current, so that the physicians listed are the ones who are available and accepting patients. That means, for example, if you're pregnant and need to find an OB/GYN who provides prenatal care and delivers babies, that the health insurer's directory information about the services offered by that OB/GYN should be accurate and up to date. As OB/GYNs mature in their career it is not uncommon for them to give up obstetrics as their patient population ages and no longer seeks that service. Listing them as an available provider for an expectant mom is dishonest.
The Illinois Department of Insurance (IDOI) has been pursuing insurers who are not abiding by the law, and fining companies that are not in compliance. However, recent fines have not had the financial impact necessary to move insurance companies to action in updating their provider directories.
In 2022, one insurance company was fined $1.25 million for violating the NAT Act and similar federal patient protections by failing to provide updated network provider directories. The health insurer also did not follow proper time/distance standards as required by the NAT Act. Health insurers must meet reasonable standards for how far a patient must travel for care. People in need of medical care should not have to travel long distances to receive it, especially in underserved regions.
The doctors of Illinois encourage the insurance companies to be better partners in health care access and for IDOI to continue to go after the insurance companies that are violating the NAT Act. If you believe a health insurance company is not in compliance with the NAT Act or any other law or regulation, please file a complaint with the Illinois Department of Insurance by calling 877-527-9431. You can also contact your state representative and senator to let them know you want the IDOI to continue to aggressively enforce the NAT Act. Our patients deserve access to the care they were promised by their health insurers.
Rodney S. Alford, M.D., is president of the Illinois State Medical Society.
