Networks at the Nexus: Revisiting New York State's Provider Network Standards and Protections

Hundreds of thousands more New Yorkers have joined insurance plans since the Affordable Care Act went into effect, and health plans are increasingly trying to control costs by offering narrow networks of health care providers. Networks at the Nexus examines consumer protections and network adequacy standards in New York and recommends a series of steps the State could take to ensure transparency and access on this issue of critical importance to health insurance consumers.

Recommendations from the report include creating a central database that allows health plans and regulators to improve the accuracy of provider directories; updating standards on minimum waiting times for appointments; improving the appeals process for consumers who want to see out-of-network providers; enhancing disclosure about whether providers are accepting new patients; supplementing new “provider look-up” tools for consumers; regularly convening providers, consumers, health plans, and policymakers to address issues with New York's standards; and more.

Read the related press release.

Additional Resources

In December 2016, a UHF roundtable brought together providers, consumers, health plans, lawmakers and New York State officials for a discussion of New York's network adequacy standards and consumer protections. The discussions and voices from that roundtable are featured in Networks at the Nexus; slide decks of the presentations from the event may be downloaded below.

  • Kate Bliss, research scientist, New York State Department of Health, provided an overview of new PNDS improvements and tools.
  • Mario Schlosser, CEO, Oscar Insurance Corporation, discussed his company's implementation of a smaller network for 2017, and the way it utilizes virtual care and high-touch service to aid members in finding and receiving care.
  • Mark Scherzer, Esq., legislative counsel for New Yorkers for Accessible Health Coverage, offered the consumer perspective.
  • Peter Newell, director of UHF's Health Insurance Project, gave an overview of network standards and review processes.