Network Adequacy - National Multiple Sclerosis Society

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Network Adequacy

People with multiple sclerosis (MS) have a variety of healthcare needs including neurological symptoms, emotional and psychological issues, rehabilitation interventions to enhance mobility and independence and long-term care. These healthcare needs vary dramatically person to person. Every person with MS needs meaningful access to a comprehensive network of providers to meet his or her unique needs.

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About This Issue

What We Are Trying To Accomplish: In the changing health care landscape and as the Affordable Care Act (the health care reform law or ACA) is implemented, we work to ensure that health insurance plans develop and maintain provider networks ensuring coverage and access to quality MS care. This can include care from neurologists, rehabilitation providers, radiologists, mental health providers and other specialists, as well as products from pharmacies, durable medical equipment (DME) providers, home care agencies and more.


Why It’s Important: People with multiple sclerosis (MS) have a variety of healthcare needs including neurological symptoms, emotional and psychological issues, rehabilitation interventions to enhance mobility and independence and long-term care. These healthcare needs vary dramatically person to person. Every person with MS needs meaningful access to a comprehensive network of providers to meet his or her unique needs. While the ACA made progress in setting general standards for provider networks, concerns linger that some insurers may be limiting access to Partners in MS Care.  Some states require private health insurers to meet network adequacy requirements for managed care plans, but these requirements vary across the country.

Updates: In some states, consumers may be purchasing health insurance plans in their states health benefit exchange or the Federal Marketplace with a much narrower provider network than they had with their previous health insurance coverage. The Society is collecting stories from people living with MS and is engaging in state-level advocacy to ensure that people have access to the comprehensive care they need. If you have purchased a private health insurance plan and must pay out-of-network rates for a neurologist, therapist or other specialist, let the Society know and learn how you can get involved in your state to address network adequacy concerns.  

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Ensure that people with MS have access to a comprehensive network of healthcare providers.

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Partners in MS Care
The Partners in Care Program supports quality, comprehensive MS care.

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Has your insurer recently dropped access to needed specialists? 

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