Dr. Kaplan criticized CMS for failing to impose third-party oversight and adequacy standards for payer networks in its final rule for 2017.
In the letter, Dr. Kaplan described how narrow insurance networks are driving more patients to seek care out-of-network due to a lack of in-network options, leading to much higher out-of-network costs. Narrow networks have also caused a spike in balance billing disputes, said Dr. Kaplan, as patients unknowingly or incidentally receive out-of-network care.
Dr. Kaplan also warned CMS about a rising number of patients delaying medical care altogether due to a lack of viable, in-network primary care physicians.
“Rather than holding insurance companies to a reasonable standard of adequacy, CMS has effectively given these healthcare profiteers even more freedom to do what they like rather than what is in the best interest of our patients,” Dr. Kaplan wrote.
Dr. Kaplan’s letter can be accessed here.
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