Health Care Delivery

Insurance Contracting

NFPRHA believes that family planning patients should be able to see their provider of choice regardless of payer. As the health care landscape continues to evolve, engaging in contractual relationships with insurance issuers will be increasingly important for family planning providers and others in the health care safety net. The health law recognizes the importance of essential community providers (ECPs) like Title X and other publicly funded health centers as part of the service delivery network. Language in the ACA requires qualified health plans (QHPs) - plans that are approved for participation in marketplaces - to include ECPs in their networks. Family planning providers were included specifically as a type of ECP in federal guidance - an important recognition of the role family planning providers play in the safety net and their experience caring for the underserved.

NFPRHA's Work

NFPRHA advocates on the federal level to ensure that network adequacy requirements, including the requirements that health insurance companies contract with ECPs, are protective and inclusive of family planning providers. NFPRHA also provides resources for providers to use during the contracting process through its policy department and the Life After 40: The Family Planning Network and the ACA project. 

Resources

NFPRHA Case Studies

• Building Blocks for Effective Relationships with Third-Party Payers & workbook (PDF) - Examines the development of successful relationships with third-party payers as experienced by three different organizations (October 2014).
  
  
• Managing Family Planning Revenue Cycles & workbook (PDF) - Presents a detailed look at how family planning providers are streamlining billing practices as they serve an increasing number of insured patients (April 2013).

Family Planning Matters Newsletter

• Essential Community Provider Policy: Challenges and Opportunities (PDF) - NFPRHA staff-authored article regarding ECP policy (Winter 2013).

For additional resources & information, access NFPRHA fact sheets and federal comments by issue or read NFPRHA's publications and recent press statements.