Growing pains: can any willing provider laws overcome the challenges of the teenage years?
Any willing provider laws were first enacted in the late 1980's as a way to combat the exclusion of providers from insurer and Health Maintenance Organization (HMO) network panels. Generally, the laws provided that insurers and managed care organizations had to admit to their provider panels any provider who was willing to accept the entity's terms and conditions for participation. These laws face two significant challenges today: how to overcome Employee Retirement Income Security Act (ERISA) preemption and the fact that the legislatures either failed to put limits on the terms and conditions that could be imposed or did not define what reasonable terms and conditions were. This article gives a basic overview of any willing provider laws, the ERISA statutory and case law that affects them, and the current problem of what terms and conditions imposed upon providers can be considered reasonable. It also summarizes many of the current any willing provider laws and notes which laws among those listed have been held by courts to be preempted by ERISA. Efforts have been taken to make this article current and accurate; however, they should not be construed as legal advice or an opinion on specific situations. Because of the rapid pace with which these laws and the cases affecting them change, you should consult an attorney concerning the existence and validity of any willing provider and similar laws in your state.
McMahon
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Wyatt, Tarrant and Combs, LLC, Lexington, KY 40507, USA. EMcMahon@WyattFirm.com