The Texas Department of Insurance's (TDI's) proposed rules governing the adequacy of physician networks in insurance plans are bizarre, misguided, "extremely poor public policy," unacceptable, inappropriate, feeble, confounding, insurer-friendly, and unsupportable, TMA President Michael Speer, MD, wrote to TDI earlier this month.
"If the Department's current path is not abandoned, it will ultimately result in irreparable harm to Texas' consumers as, inter alia, the value of the products they have purchased will be reduced; their out-of-pocket expenses will be increased; and unjust and deceptive policies will (by the Department's own admission) be allowed in the market for purchase by unsuspecting consumers," Dr. Speer wrote.
TMA, TDI, and the health plans have been involved in lengthy negotiations over the rules since TMA pushed passage of network adequacy laws in the 2007 and 2009 sessions of the Texas Legislature. Shortly before they were to take effect, TDI Commissioner Eleanor Kitzman late last year suspended a solid package of rules TMA helped to put together.
Action, Dec. 17, 2012