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Klausmeier & Kelly: We need transparency, consumer rights for health care

In this day and age, having insurance is one thing, but actually finding a doctor that can see you is another. Have you ever needed to see a doctor, but couldn’t find one in your insurance directory? If you did find one, has it ever taken you months to get on their appointment schedule? Have you ever given up out of frustration and just made an appointment with a provider who could see you sooner, but wasn’t covered by your insurance? You are not alone.

Many of us are grateful to have insurance to cover our health care needs, but unfortunately insurance is not a panacea for every medical issue. Time and again we hear from constituents that health care provider directories are not up-to-date and don’t contain all of the needed information to get the necessary care.

One constituent told of the need to see an orthopedic surgeon. However, the only provider she could find for her specific medical issue couldn’t see a new patient for three months and wasn’t covered by her insurance — meaning she would have to pay out of pocket. Her bills for this important medical care totaled more than $3,000.

Another told of combing through the provider directory for a psychiatrist, but only four of the 10 she called were actually psychiatrists, and only one of those could see her within a month and a half. One recent study by the Mental Health Association of Maryland found that 57 percent of psychiatrists listed in provider directories could not be reached due to inaccurate information, including specialty errors or because they were no longer in practice.

In another study, the Maryland Women’s Coalition for Health Care Reform found that less than one in four out of 1,493 OBGYNs were available for new patients seeking a well-woman visit in four weeks or less. And 36 percent of OBGYNs listed in the directory were unavailable due to inaccurate contact information, an incorrect specialty categorization or no longer being in practice.

These are real problems facing Marylanders every day. We need accurate provider directories that have up-to-date information and contain providers that can actually see new patients when health care is needed.

Marylanders are frustrated and don’t know where to turn to get the information they need. They question why they should have to pay out-of-pocket costs to get health care when they already have insurance. Understandably, they wonder how the system is actually working for them.

After hearing from many of our constituents about their challenges and the problems they are facing, we must do something. After reading recent studies by health care advocates that outline the problem and studying recent model legislation created by the National Association of Insurance Commissioners after 18 months of research, we now have a solution.

Our proposed legislation (Senate Bill 929 and House Bill 1318) provides for stronger consumer rights and greater transparency, requires both accurate and adequate information in provider directories and ensures clear and specific network adequacy standards that are enforceable. These are not unique policies. In fact, Maryland is in a very small minority that does not already have them.

Twenty-nine states have quantitative, measurable standards such as maximum travel times or distances to a certain provider. Others have maximum appointment wait times or provider-to-enrollee ratios. Under rules proposed by the Centers for Medicaid & Medicare Services, in 2017, the 34 states that use the Federally Facilitated Marketplaces will be required to meet similar standards.

As a result, in 2017 only the District of Columbia and six states will have no quantitative standards in place to protect them and ensure adequate networks. If our legislation does not pass into law during this legislative session, Maryland will be among the states that will be left behind.

Thirty-three groups within Maryland, including the Maryland Hospital Association and the Mental Health Association of Maryland, support this common-sense legislation. They all agree that one more Marylander shouldn’t have to pay out of pocket because he or she can’t find a health care provider covered by their insurance. They all agree that new patients should not have to wait 45 days to see a health care provider. They all agree that provider information in directories should be accurate — listing the specialty, contact information and whether or not the provider is accepting new patients.

Marylanders across this great state have stories that belie the frustration, confusion and expense created by not having these policies. We must work together to ensure we can all find providers who can actually provide the treatment their patients are seeking.

State Sen. Katherine Klausmeier is a Democrat who represents District 8 in Baltimore County. Del. Ariana Kelly is a Democrat who represents District 16 in Montgomery County.