MAP network guarantees in bill to extend funding for government through March 2026

[annon123]

I was reading the summary of the bill to extend funding for the government through Mach 2025 and saw this:

"It also cracks down on so-called "ghost networks" in privatized Medicare plans, by protecting Medicare Advantage beneficiaries from hefty cost sharing if they get services from a provider listed in their plan's directory but who isn't actually in network."

That should really help protect patients from surprise bills and force the insurance companies to keep network lists updated.

The article focused on the medical care issues/health insurance issues, etc, in that bill

So lets hope this gets passed. Article says it has bipartisan support.

Stopgap funding bill includes sweeping PBM reform, preserves telehealth flexibilities

The bipartisan agreement will fund the government through March. It could also reshape the pharmacy supply chain by reforming how controversial drug middlemen do business.

www.healthcaredive.com

 

[somarco]

"It also cracks down on so-called "ghost networks" in privatized Medicare plans, by protecting Medicare Advantage beneficiaries from hefty cost sharing if they get services from a provider listed in their plan's directory but who isn't actually in network."

That should really help protect patients from surprise bills and force the insurance companies to keep network lists updated.

Networks are constantly changing in much the same way as drug formularies change.

AFAIK, carriers rely on electronic (website) directories which should be updated regularly. Insureds can also call the 800 policyholder service line and get the most recent list.

I am not a fan of managed care plans but this seems almost like a nothing burger.

 

[annon123]

Networks are constantly changing in much the same way as drug formularies change.

AFAIK, carriers rely on electronic (website) directories which should be updated regularly. Insureds can also call the 800 policyholder service line and get the most recent list.

I am not a fan of managed care plans but this seems almost like a nothing burger.

I would suspect that this made it into the bill because of problems with at least one carrier and perhaps more than one where the list wasn't updated the way it should be. The problem companies may well be a tiny minority and so, as you say, it may be 'much ado about nothing' for most companies. Even if that is the case this should serve to encourage any "problem" companies to fix their issues and keep the lists always current which would be a good thing for their insured.