Proponents of Any Willing Provider laws say they address a systemic barrier to health care services created by insurance companies not accepting qualified providers in their network. (Photo by Daniel Clark)

State Sen. Roberta Lange (D-Las Vegas) tested the waters for a bill that would address Nevada’s ongoing health care provider shortage by mandating that insurance companies accept a provider who meets their qualifications and applies to be in their network. 

It’s known as an “Any Willing Provider” law, but Lange abandoned it in favor of a far narrower scope.

“I tested the temperature and in our state, I couldn’t get a bill passed that was an Any Willing Provider law,” said Lange. “I took it to the (UNLV) medical school. They wanted an Any Willing Provider law, but it’s not going to pass in Nevada.”

Lange declined to name specific interests or persons who convinced her an Any Willing Provider bill would not pass.

Dr. Marc Kahn, dean of the Kirk Kerkorian School of Medicine at UNLV, supports a broad Any Willing Provider law but acknowledged it is a hard sell. Insurance companies don’t want to expand access to care by having more providers, and doctors in-network don’t want more competition, he said in an interview with the Current.

The bill Lange did introduce, along with Senate cosponsors Pat Spearman (D-North Las Vegas) and Fabian Doñate (D-Las Vegas), Senate Bill 146, would prevent health insurance companies from denying a provider who applies to be in their network and meets their qualifications — but it would only apply to providers who have an offer of employment or residency at a Nevada school of medicine.

“This isn’t Any Willing Provider,” Lange said. “My bill is only for the medical schools. It’s a very small, carved-out group of people.”

Lange says the bill aims to address a situation that happened after the Kirk Kerkorian School of Medicine at UNLV lost a cardiologist who was accepted to teach at the school but couldn’t get credentialed by an insurance company. 

Lange said this year’s legislation “is a start” at breaking down the barrier to care that critics say has been erected by insurance companies declining to allow providers into their networks. 

“We have such a shortage,” she said. “I just waited with my grandson, who lives with me, for four months to get into a doctor. It was the first available appointment, and if you have a health care problem, that’s an atrocity.”

Providers want broader Any Willing Provider laws in Nevada

Currently, 35 states have Any Willing Provider laws on the books.

Proponents of broad Any Willing Provider laws say they address a systemic barrier to health care services created by insurance companies not accepting qualified providers in their network. 

Specialists in Nevada who seek to provide care are often not accepted into networks by insurance companies through a process called paneling or credentialing, where a board of doctors in an insurance company decides whether to accept a new provider.

“I’ve met with the health care companies and I said ‘Look people are telling me they’re trying to get on the panels and they can’t. They’re being told they’re full,’” Lange said. “The health care companies said it was news to them. Yet, when people came up to testify [at the Feb. 23 hearing] they were told it was full, so I think in our state we have a bigger problem.”

Health care providers and others during a Senate Committee on Health and Human Services hearing for SB 146 on Feb. 23 expressed support for addressing broader insurance issues.

One of those people was Rob Phoenix, a family nurse practitioner and owner of the nonprofit Huntridge Family Clinic, the largest LGBTQ+-focused medical clinic in Southern Nevada. There, he and his team provide services for HIV treatment and prevention, transgender health care, primary care, Post Exposure Prophylaxis (PEP) care, and Pre-Exposure Prophylaxis Prevention (PrEP) care.

Phoenix said that every six months for the last five years he has sent a letter to Culinary Health Insurance asking to be accepted in-network. And he said every six months for the last five years, Culinary Health Insurance responded to the request with “we’re already full we don’t need more panelists.” The patients who sought Phoenix’s services with that insurance paid out of pocket. 

“We get this constant pushback that you’re already full. You are full of something and it isn’t providers,” Phoenix said at the hearing.

In the three years since the state began tracking denials, the top reason for specialists to be denied acceptance into an insurance plan was the specialty was not needed or it was outside of the service area, according to the review of insurance denials by the Nevada Department of Insurance (DOI) for 2020, 2021 and 2022. That reason was cited at more than three times the rate of every other option given.

In 2020, across all specialties, 324 providers were denied entry to insurance company networks in the state. In 2021, a total of 624 providers were denied. In 2022, 918 providers were denied. 

The Nevada Psychological Association (NPA), which represents licensed psychologists in the state, is neutral on the bill. They noted that while the bill is a step in the right direction, it won’t expand access to mental and behavioral health services in a state that desperately needs it.

“We believe Section 4 of S.B. 146, allowing providers associated with medical schools to become credentialed by any insurance network, is an important step toward increasing access to care for Nevadans but we do not think it goes far enough. NPA supports expanding “any willing provider” legislation in Nevada in order to meet our need to increase access to care for all,” NPA representatives wrote in a letter. 

The failed 2015 effort for narrow Any Willing Provider bill

This isn’t the first time an attempt at a narrow Any Willing Provider bill has come in front of the Nevada Legislature. In 2015, an assembly bill that would limit denying providers and chiropractors was confined to people seeking care under the state workers’ compensation program. The 2015 measure was backed by Republicans who said it would produce “better patient care” and provide more “free market health access,” during an Assembly Commerce and Labor Committee hearing. 

Representatives from the insurance industry, the Vegas Chamber, the Retail Association of Nevada, the Nevada Manufacturing Association, and other interests testified against the bill in 2015. 

Long-time lobbyist James Wadhams, representing the American Insurance Association, said at the time that the legislation interfered with businesses negotiating with insurance companies. The single hearing was as far as the bill got, and it expired in committee.

Wadhams and lobbyists for other interests that opposed that 2015 bill did not respond to requests for comment about the short-lived effort to enact broader Any Willing Provider legislation this year.