maintenance of networks by health carriers and to
ensure the adequacy, accessibility, transparency, and
quality of health care services. Most state legislatures
were not focused on amending their laws to reflect revisions in the model act in the current legislative sessions,
as it was just adopted by the NAIC in November 2015.
However, 2017 may be a pivotal year for states to take
up the model act. 5
Any willing provider
During the early years of HMO development, similar
issues came to bear with regard to network limits on access
to physicians. Many patients were unhappy that they had
to pick a gatekeeper in the HMO’s network in order to get
a referral to a specialist. In response, states adopted “any
willing provider” laws that require health insurance carriers to allow health care providers to become members of
the carriers’ networks if certain conditions are met. Such
statutes prohibit insurance carriers from limiting membership within their provider networks based upon geography
or other characteristics as long as a provider is willing
and able to meet the conditions of network membership
set by the carrier. At present, 27 states have adopted “any
willing provider” statutes. 6
Preparing for the future
Because most state legislatures have yet to address the
challenges of narrow/tiered networks and surprise billing, it is likely that this will be a hot issue at the state
level in 2017. Until then, it is important for surgeons to
be engaged in efforts in the medical community in their
states, as it will be challenging to convince lawmakers to
adopt legislation that will meet the needs of physicians,
insurers, and, most importantly, patients.
The College encourages surgeons and ACS chapters to
not only engage in the medical community’s grassroots
advocacy activities related to this issue, but also to notify
the State Affairs staff in the College’s Division of Advocacy
and Health Policy at firstname.lastname@example.org if legislation
is introduced or a legislative initiative is proposed by a
professional organization in the state. ♦
1. American College of Surgeons. Statement on Physician
Tiering and Narrow Network Programs. Available at:
Accessed April 26, 2016.
2. New York Department of Financial Services. Protection
from surprise bills and emergency services. Available
Accessed April 26, 2016.
3. Becker AL. Cheat sheet: What’s in the big health care
bill. Connecticut Mirror. June 1, 2015. Available at: http://
health-care-bill/. Accessed April 26, 2016.
4. Florida H.B. 221. An Act Relating to Health Care
Services. Available at: www.flsenate.gov/Session/
Bill/2016/221. Accessed April 26, 2016.
5. National Association of Insurance Commissioners.
Network adequacy. Available at: www.naic.org/cipr_
topics/ topic_network_adequacy.htm. Accessed April
6. National Conference of State Legislatures. Any willing
or authorized provider. Available at: www.ncsl.org/
aspx. Accessed April 26, 2016.