Is there really continuity of coverage?

Health insurance, when at its best, can be a bit confusing and overwhelming as it is, but there are times when it seems downright unfair.

One such instance of arguable lack of fairness, in a system that often seems designed for frustration, is this: Patients can change insurance only during end-of-year open enrollment periods or at the time of "qualifying life events," such as a divorce or job change that trigger special enrollment periods or SEPs. But insurers' contracts with doctors, hospitals and pharmaceutical companies, or their benefit managers, can change abruptly at any time.

This is particularly galling and possibly harmful for patients, because whether obtaining insurance through an employer or buying it on the marketplace, people generally choose a policy based not just on price and benefits, but whether it covers their desired doctors and hospital, or an expensive drug they need.

It turns out that coverage from a favorite doctor could evaporate at any time during the policy term. This current practice may put consumers at risk and obstruct their access to care and treatment, not to mention increase their level of stress and anxiety.

As you would expect, this situation elicits the expected human response of anger and confusion, especially if you are told that somewhere buried on page 60 in your policy contract is a nebulous sentence or two that suggests in-network providers may change at any time.

My attorney friends tell me that state and federal regulators have the authority to regulate insurers' networks and could end the practice in order to safeguard continuity of coverage. But until now, there hasn't been federal regulation about continuity of coverage, or particularly how to define it.

Many insurers say they will continue paying for a period after a contract ends — often 60 to 90 days — or to complete an "episode of care," for a pregnancy, in particular. But with, say, cancer, would that mean one round of chemotherapy or the full course of treatment, which could last for years? Is it really continuity of coverage if a patient must change oncologists midstream or if a patient must leave an effective therapist?

To be sure, there are rate transparency issues and recent legislation undercurrents that are fueling the apparent surge in provider contract disputes between insurers and providers, but there needs to be a sense of urgency established to resolve or mitigate the current situation.