How can you select a health plan or obtain services without knowing what providers are in the plans’ networks?

 Ohioans have complained about not being able to access the health care provider information they need to choose a health plan and not being able to confirm that a provider is in their network once they have enrolled in a health plan. That’s why Ohio Consumers for Health Coverage was initially pleased that the Ohio Department of Insurance published a draft rule on network disclosure. However, as we read through it, we also had some concerns, leading us to file written comments on both the first and second drafts of the rule (on Feb 20 and Mar 27^th respectively).

 Many provisions represent a step forward. The draft rule requires insurance plans to ensure that the format and content of a provider directory is not deceptive or misleading by complying with specific requirements. Insurers must update directories quarterly and within 15 days of getting notice that a provider is being added or leaving a plan or changing hospital affiliation. The rule also states that an enrollee shall not be required to enter an ID number to access the directory and defines “enrollee” broadly. It establishes certain reports that the Insurance Commissioner can request from insurance companies to measure compliance.

 However, OCHC made several recommendations to the first draft. We would like the review and updates to be more frequent. The rule states that the Commissioner “may” request certain data from the insurance company. We urged that “may” be changed to “shall” and that more extensive data be requested. 

 In the second draft of the rule, a provision was added that makes the reports filed by insurance companies confidential and not available to the public. OCHC protested strongly against that addition in its second comments. There is no purpose to be served by this lack of transparency.