Network Adequacy

When consumers enroll in a health insurance plan, they gain access to a network of medical providers. Insurance companies contract with a range of providers, including both primary care and specialty physicians, to deliver health care services included within the plan’s benefit package. This network of providers must be adequate to ensure that consumers enrolled in the plan have reasonable access to all covered benefits. This is what is meant by network adequacy. 

Are newly insured Georgians accessing the care they need? For the most part, the answer seems to be yes, but there are also some warning signs on the horizon. As narrow provider networks become more common, health care consumers need accurate and more usable information about the size and composition of provider networks to make meaningful choices about health insurance. In addition to transparency measures like enhancements to provider directories, Georgians for a Healthy Future also supports updating Georgia’s network adequacy laws and regulations to ensure that consumers can access a provider in their network for all covered benefits. 

Learn more about our advocacy around network adequacy and provider directories through the resources and information on this page. 

Learn More About Network Adequacy

“Directory errors can be common. For example, a “secret shopper’’ survey done by Georgians for a Healthy Future found numerous errors in four “silver-level” HMOs in Atlanta that the consumer…

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