Health insurance to help you, not break you

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When picking a new health insurance plan for your family, figuring out which doctors and hospitals are in a company’s network shouldn’t be guesswork. Companies should keep their web sites up to date. That’s not asking too much.

If you’re being treated for an illness such as cancer, or you’re in the last trimester of a pregnancy, and your insurance company drops your hospital from its network plan, your care should not be interrupted. You should be able to continue treatment at the network rate for a while. That, too, is not too much to ask.

And if you need a specialist — for anything from a broken leg to a heart condition — there should be one available in your network. Unless you really live in the sticks, you shouldn’t have to drive very far to get care. That seems obvious.

You might think all three of these basic rules and services are standard for health insurance coverage, but they are not in Illinois. To put them in place, we urge the passage of the Network Adequacy and Transparency Act proposed by Democratic Rep. Greg Harris of Chicago.

The bill, which has strong bipartisan support, also would require insurance companies to provide customers with 60 days notice in most cases when they drop a doctor or hospital from their network.

Too often, customers find out their insurance company has dropped a provider when they call their doctor’s office to make an appointment or when the bill arrives.

“I’m going to have to either stay with my doctor at the out-of-network rates or I’m going to have to find another doctor,” Dr. Thomas M. Anderson, president of the Illinois State Medical Society, said of the stressful choice customers face. “Those are hard choices to make on the fly, especially if you’re in the middle of an intense situation of care.”

Under the bill, people fighting life-threatening illnesses, and women nearing the end of their pregnancies, would have flexibility to continue their care for 90 days at network rates in most cases when their doctors or providers are dropped.

“There have been no protections for consumers in these situations,” Harris. “They had a choice of continuing with their old provider and paying out-of-pocket rates as opposed to an in-network rate. Or, they’d have to start over with a new provider if they can find a new provider in the network that would take them.”

People shouldn’t have to suddenly sacrifice care when they are at the most vulnerable points of their lives. We’re talking about minimum guidelines for a vital service — health care.

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