Monday, June 9, 2014

Psychiatry Urges AMA to Address Health Plan Network 'Inadequacy'

Physicians at this year's annual policymaking meeting at the AMA were widely supportive of a resolution brought by the AMA Section Council on Psychiatry to address the problem of health plan network “inadequacy” and efforts by health plans to restrict access to specialists.

Section council representatives told delegates that insurance plans are appearing within the new health exchange networks that offer “thin and ultra-thin” networks—provider lists with few or very few specialists. Moreover, patients also face “phantom networks,” a phenomenon whereby plans list providers in their networks who are not really available to treat patients, or in some cases who are deceased.

The section council resolution, which received supportive testimony from physicians in several disciplines, seeks to have AMA advocate for adherence to existing statutory and regulatory measures for ensuring network adequacy and to work with state medical societies to advocate for such regulations in states where they do not exist.

Psychiatrist Paul O’Leary, M.D. (pictured above), told delegates that the problem of network inadequacy and health plan efforts to restrict access to specialists can be especially problematic for young physicians starting out in practice and seeking to be included on panels or receive referrals of patients.

O’Leary made his remarks yesterday during reference committee hearings where reports and resolutions are debated before being sent to the full House of Delegates; the House will be meeting today through Wednesday to discuss the section council resolution and many other issues.

Look for additional Alerts and upcoming editions of Psychiatric News for in-depth coverage of this and other issues of importance to psychiatry.

(Image: Mark Moran)


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