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AMA, physicians seek more regulation on provider networks — 5 highlights

The American Medical Association, American Academy of Family Physicians and other organizations are imploring insurance commissioners and the Obama administration to scrutinize health plans with narrow lists of medical providers, according to Forbes.

Here are five highlights:

1. The physician groups are calling on state legislatures and CMS to update their "network adequacy" statuses to make sure patients have a sufficient supply of physicians.

2. AMA President Steven Stack, MD, said legislators need to more closely regulate payers. "Patients are strongly attracted to lower premiums and we're relying on regulators to ensure that the product they are buying is a reasonable insurance product. Insurers should be required to have standard networks," he said.

3. In lieu of financial losses, many payers such as UnitedHealth Group, Anthem and Aetna are pushing plans with narrow networks to control costs.

4. The Blue Cross and Blue Shield reported that health maintenance organizations and "exclusive provider organization products" which limit providers "within a predetermined network" increased to 52 percent of health plan offerings on public exchanges in 2016.

5. Dr. Stack said regulators should ensure patients do not have to travel more than a certain distance to see a physician and ascertain a given area has a "minimum ratio" of network providers.

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