A sufficient number of physicians to service the insured population in each geographic area is key to adequate access. Medical facilities, such as hospitals, outpatient treatment centers and specialty treatment centers, must be conveniently located.
Access also depends on hours of operation and the accommodation of members with special needs.
This information should be provided on request, but is especially important when a plan is selected and during open enrollment periods. In addition to a provider directory, many plans provide members with an 800 number that can be used to find out whether a provider is still in the plan or whether new providers have joined since the last directory was published. A. Employees can be surveyed to determine which providers they want in the network. If those providers are not already included in the network, they can be solicited to join so long as they meet the quality standards set by the plan. The proximity of providers to members homes and workplaces can be determined by comparing the zip codes of providers with employee zip codes.