Network Transparency is all about making sure consumers have the information they need when shopping for a health insurance plan. Health insurance networks are made up of many different contracts between healthcare providers, such as doctors or facilities, and the insurance company. The Department is working to protect the consumer's right to know what doctors and hospitals are in their network.

 

Why is Network Transparency Important ?

Transparency in networks is essential for consumers to know what they will have to pay for their healthcare services. For example, should a consumer access care from a provider that is not in their network, additional expenses usually occur. That's why the Department is working to make sure network information is readily available.

 

In order to ensure that consumers can make informed decisions, health insurance companies maintain provider directories. The proposed rule requires that directories include up-to-date information about the provider, including contact information and whether the provider is accepting new patients. The Department wants to make sure that the insurance companies are keeping this information regularly updated on their websites.

Preventing unexpected costs

Consumers can be hit with unexpected costs if they see a doctor who is not in their network.  That’s why the proposed rule holds the insurance companies accountable for ensuring that the provider directory is as up-to-date as possible.  In addition, insurance companies should explain how out-of-network costs are calculated, so consumers can make informed decisions.

OPPA members are encouraged to talk with their patients and ask them to take the four-question survey being conducted by ODI:

http://insurance.ohio.gov/Consumer/Pages/ProviderNetworkTransparency.aspx