Network Adequacy
Insurers Are Blocking Access to Care
Network adequacy laws are meant to ensure that patients can see the right doctor, close to home, when they need care. But insurance companies have turned those rules into loopholes.
THE FACTS
59 days is often how long it takes before a transfer occurs due to network inadequacy issues.
Over 50% of NC's 100 counties face network inadequacies
THE NETWORK ADEQUACY CRISIS IN NORTH CAROLINA
Insurers build provider networks to meet requirements for time and distance, but these standards don’t tell the whole story. They don’t account for whether providers are actually accepting new patients, they offer the right specialty care for patient needs, or whether they have the staff and resources to meet patient demand. As a result, many North Carolinians are stuck waiting for care, traveling long distances, or receiving care in settings that aren’t right for their needs.
Hospitals are left absorbing the fallout. Especially in rural areas, limited networks push patients farther from care, delay discharges, and add strain to already overburdened providers.
WHEN NETWORKS FAIL, PATIENTS SUFFER
When insurers limit access through narrow or underfunded networks, the consequences ripple across the healthcare system:
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Patients wait weeks or months for necessary specialist visits, tests, or treatments, which can lead to worsening health outcomes and quality of life.
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When provider networks aren’t sufficient, hospitals may have to delay transferring patients to post-acute care facilities, resulting in extended hospital stays, higher costs for the patient, and limited hospital access for new patients.
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Delays and inadequate provider networks can lead to more expensive care, longer treatments, and surprise bills when the care they were promised “in network” isn’t actually available.
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With rural healthcare providers already stretched thin, rural communities are disproportionately impacted by network inadequacies.
Recent statewide polling confirms what communities have long felt: Hospitals are trusted – insurance companies are not. Most North Carolinians say insurers are to blame for the rising cost of care.
WE NEED REAL ACCESS, NOT OVERPROMISES
This system is broken. It’s time to restore meaning to “in network.” North Carolina lawmakers and regulators can hold insurance companies accountable and make care accessible again by calling for:
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Expanded network adequacy standards to ensure provider networks can meet patient needs, especially Medicaid beneficiaries.
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Stronger oversight and enforcement to ensure compliance with network adequacy standards.
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Insurance networks support – not undermine – rural hospitals and providers that keep care within reach.
Let’s Heal the System Together
Insurance companies have had too much control over our healthcare system, and North Carolinians are paying the price – literally. Providers are doing their part. Now insurers – and the lawmakers who regulate them – must do theirs. Let’s start healing the system by first stopping the financial harm to healthcare providers and the patients they serve.
