Policy Supports Easing Burden of Out-Of-Network Care

During the 2017 American Medical Association (AMA) Annual Meeting, a panel discussed the need for policies to support patients with serious conditions who switch health plans while receiving care for serious conditions, chronic conditions, or pregnancy.

The panelists noted that disruptions in care caused by out-of-network costs incurred while switching health plans can occur because patients undergoing treatment are reluctant to stop seeing physicians that they trust. This disruptions can occur among patients receiving treatments for cancer or those in their second trimester of pregnancy.

The council recommended that patients who switch health plans while receiving treatment for serious conditions “should also have the opportunity to receive continued transitional care from their treating out-of-network physicians and hospitals at in-network cost-sharing levels.”

The AMA noted that they will continue to support legislation that protects patients’ continuity of care during health plan transitions, or those whose physicians leave a health plan’s network.

“The AMA should develop model state legislation to address coverage and payment for out-of-network care,” the AMA wrote.

The policy also addressed the burden of sudden, unanticipated health care costs incurred by patients who are treated by contracted out-of-network physicians within hospitals that are in network.  The AMA stated that “Insurers must be transparent and proactive in informing enrollees about all deductibles, co-payments and other out-of-pocket costs that enrollees may incur.” —David Costill