Network Adequacy

In Network,
But Unavailable

Network adequacy is meant to ensure that patients have timely access to the care they need from providers covered by their insurance. But in North Carolina, gaps in provider networks are leaving patients without options – especially those on Medicaid health plans where networks are limited.

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, whether 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.

WHEN NETWORKS FAIL, PATIENTS SUFFER

When insurance networks fall short, serious challenges for hospitals, healthcare providers, and, most importantly, patients may result:

Patients could wait weeks or months for necessary specialist visits, tests, or treatments, which can lead to worsening health outcomes and quality of life.

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.

Delays and inadequate provider networks can lead to more expensive care, longer treatments, and unexpected out-of-network charges.
With rural healthcare providers already stretched thin, rural communities are disproportionately impacted by network inadequacies.

WE NEED REAL ACCESS, NOT OVERPROMISES

This system is broken. Being “in-network” should mean having access to care. It's time to hold insurers accountable to ensure every North Carolinian can get their necessary care. We need:

Expanded network adequacy standards to ensure provider networks can meet patient needs, especially for Medicaid beneficiaries.

Stronger oversight and enforcement to ensure compliance with network adequacy standards.

We deserve access to care. Join us in healing the system.

A Better Healthcare Future for North Carolina.

Join Us in the Fight for Healthcare Transparency.

We invite policymakers, business leaders, advocacy groups, and engaged citizens to join us in demanding a fairer healthcare system. Together, we can shift the conversation, hold insurance companies accountable, and drive meaningful change in North Carolina.