Americans continue to struggle with rising health care costs, including high deductibles and other out-ofpocket expenses. As such, a balanced solution for cost-sharing between patients, physicians and health
plans is a priority for organized neurosurgery. Patients deserve access to the physicians of their choice
which at times may require seeking care from out-of-network physicians. Unfortunately, the current health
care delivery system, with its arcane rules, narrow networks, and lack of transparency, often leaves patients
vulnerable. As physicians, we can, and must do better, to assure that our patients are not left with
unanticipated medical bills that can soar into the thousands of dollars, leaving them financially vulnerable.
The problem of unanticipated out-of-network bills is complex, and requires a sensible solution. In addition
to providing strong patient protections, we believe the principles set forth below would improve
transparency, promote access to appropriate medical care, and avoid creating disincentives for insurers and
health care providers to negotiate network participation contracts in good faith. As Congress develops
potential legislation to provide relief to patients from health care costs that their insurance will not cover,
the AANS and the CNS believe that the following shared principles of consensus should apply in all
situations, whether the health plans are regulated by the states or federal government.
- Adopt network adequacy standards. Insurers must meet appropriate network adequacy standards
including, but not limited to, an adequate ratio of emergency physicians, hospital-based physicians, and
on-call specialists and subspecialists to patients, as well as geographic and driving distance standards
and maximum wait times. Provider directories must be accurate and updated regularly to be useful to
patients seeking care from in-network providers. - Physicians want to participate in health plan networks. The vast majority of physicians, including
neurosurgeons, want to participate in-network with insurance companies, but can only do so when
insurers negotiate in good faith for fair reimbursement. - …
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