The insurance commissioner issued controversial rules mandating that insurers explain referral and authorization practices to consumers. Meanwhile, a study details how nearly half the plans available through federal and state exchanges didn't list what drugs patients had access to on their websites and Politico Pro questions whether more states will join the federal exchange.
The Seattle Times: Insurance Chief OKs Rule For Health-Plan Networks
Despite criticism from both insurers and hospitals, [Washington] Insurance Commissioner Mike Kreidler adopted a new rule Monday that spells out what health insurers must do to make sure their networks of hospitals and doctors can provide covered benefits to patients. For patients, the general thrust of the rule, which affects plans offered for coverage in 2015, is “no surprises.” It requires insurers to spell out how their benefit arrangements affect patients’ pocketbooks, clearly explain referral and authorization practices, tell policyholders whether emergency-room doctors in an in-network hospital’s emergency room are also in-network, and update directories of in-network providers monthly (Ostrom, 4/28).
The Hill: Study: Details On Drug Coverage Missing From Obamacare Websites
Nearly half of plans available through Obamacare’s state and federal insurance exchanges didn’t list what drugs patients had access to or made that information difficult to find on their websites, according to a new survey. The study, conducted by Avalere Health, analyzed consumer experience on healthcare.gov in five states and another 12 state-run insurance exchanges. In 38 percent of cases, plans did not include a drug formulary, a list of covered medications. In another 11 percent of cases, the list of covered drugs was “difficult” or “very difficult” for consumers to find (Al-Faruque, 4/28).
Politico Pro: Exchange Flops Forcing Hard State Decisions -- Hold Or Fold?
Oregon just became the first state to bail on its Obamacare exchange, scrapping its broken enrollment website and letting the federal government take over. But it may not be the last. A half-dozen other states that tried to run their own exchanges this year suffered expensive, embarrassing flops that have raised the prospects of a federal takeover. Although the national narrative has focused largely on the turnaround of healthcare.gov -- the federal exchange used by 36 states -- these failures threaten to overshadow progress in some of the most pro-Obamacare territory in the country (Cheney, 4/28).