Consumers’ ability to make use of their health insurance depends heavily on their ability to see in-network doctors, as health plans generally offer limited or no coverage of care from providers outside their networks. However, for a consumer to determine whether a particular doctor is in their plan’s network they must get through a process riddled with obstacles and pitfalls. One of the biggest barriers is relatively basic – just finding the correct provider-network is difficult, with a high likelihood of arriving at the wrong network.
The lack of clear, codified system to identify provider networks also impedes the development of many useful consumer tools. For websites, apps, and other tools to provide easy and accurate answers for consumers, they need to be able to query any doctor by the National Provider Identifier (NPI) and get a straightforward “yes or no” answer about whether the doctor is in-network for that consumer’s health plan. That in turn requires the consumer to be able to easily ascertain which network their plan is actually part of. At present that task is so difficult it is effectively out of reach for all but a small subset of consumers with the health system savvy, research skills, and time to correctly identify their network.
To improve consumers’ ability to simply and accurately determine whether or not a provider of interest is in-network, we propose the development of a standardized Consumer Network Identifier. In short, every network should be enumerated Consumer Network ID that uniquely identifiers the network *as experienced by a consumer* – i.e. the exact set of providers covered by that consumer’s plan. That network identifier should be prominently placed on the plan’s member ID card, along with a QR code that allows a consumer to go the provider directory page that corresponds to their specific network.
Enumerating networks according to a well-designed scheme would have numerous benefits for consumers, application developers, and even insurers themselves, by helping consumers better understand the network and its value to them. We examine the problem, potential ways to implement the Consumer Network ID, and benefits of this proposal in the slides below.