New Timely Access to Care Standards Adopted by CA Department of Insurance

On March 9, consumer advocates cheered the new standards announced by the California Department of Insurance for health insurers to create and maintain accurate provider directories. The new standards also require insurers to have adequate numbers and types of providers in their networks so consumers can get the care they need when they need it.

These new standards make sure all California consumers can find a provider in their network and access to the care they need in a timely manner. All insured Californians should have basic access to timely care and not have to deal with an inaccurate provider directory when looking for an in-network doctor.

While many of these consumer protections have been in place for health plans regulated by the Department of Managed Health Care (DMHC), which covers care for the vast majority of the market, CDI’s new regulations extend these assurances to the couple million Californians with coverage regulated by CDI. Part of these regulations implement SB 137 (Hernandez), sponsored by Health Access, which requires insurers to have accurate and updated provider directories.

Health Access applauds Insurance Commissioner Jones for putting these important patient protections in place. People pay their health insurance premiums regardless of how broad or narrow the network, with the expectation that they will be able to get the care they need when they need it. These standards help make sure that insurers keep their promise to patients.

CDI’s attention to these issues also provides momentum for addressing the problem of surprise medical bills from out-of-network providers when patients use an in-network facility. While the new regulations may help reduce the incidence of consumers inadvertently going out-of-network, they do not solve the full problem and a change in law is needed. The legislature should take action quickly to prevent surprise medical bills, when patients who follow their insurers’ rules and go to in-network facilities but still end up with bills from out-of-network doctors that cost hundreds if not thousands of dollars

Health Access is sponsoring AB 533 (Bonta), which ensures that if consumers do the right thing by visiting in-network hospitals or facilities, they will only be responsible for paying in-network charges and co-pays for all the providers they encounter during their visit. The total amount of cost-sharing will also count toward their out-of-pocket-maximum.

Health Access will continue to advocate for AB 533 this legislative session. If you or your organization would like to join the effort, please contact Bethany Snyder at bsnyder@health-access.org

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