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Bill to require secret‑shopper audits draws sharp debate over feasibility, costs and rural provider limits
Summary
Senate Bill 546 would give the insurance regulator authority to require ‘secret‑shopper’ appointment‑availability audits across the commercial market. Advocates and mental‑health groups supported audits to enforce access standards; the Insurance Department urged careful rulemaking and raised operational concerns about solo providers and administrative cost. Insurers warned of extra expense and questioned whether audits would solve provider shortages.
Sen. Cindy Rosenwald told the Senate Health & Human Services Committee SB546 would ensure Granite Staters can schedule in‑network care within time and distance standards—by requiring secret‑shopper surveys that simulate patient calls to test appointment availability. “These surveys use independent callers posing as patients to test whether medical appointments are actually available,” Rosenwald said.
Michelle Heaton, director of Life & Health at the New Hampshire Insurance Department, supported the goal of stronger enforcement but cautioned the committee that secret‑shopper approaches can be technically difficult and administratively costly. The department explained that New Hampshire already enforces one of the country’s more stringent network adequacy rules and has been drafting rule updates to align with federal standards; it said certain audit methods are hard to use in mental‑health or solo‑practitioner settings because missed callbacks could reflect staff limits rather than intentional directory error.
Supporters including Deborah Steinberg (Legal Action Center), New Futures, NAMI, and other provider and patient advocates argued enforcement tools are necessary because directories and time‑and‑distance standards can fail in practice. “If they're not getting a call back, they're not making that appointment either,” one advocate said, urging that audits replicate consumer experience. Insurers — including Anthem and Harvard Pilgrim — opposed the mandatory secret‑shopper approach, citing administrative burden, the role of providers in updating availability, and the risk of higher premiums.
Nut‑graf: The committee heard a clash between enforcement advocates who say audits reveal “ghost networks” and insurers and the Insurance Department who emphasize operational complexity and unintended costs. The department offered to circulate draft rule language and recommended a deliberate rulemaking process; members asked for more fiscal and operational detail before moving forward.
Key questions: whether secret‑shopper audits actually improve access in rural areas with scarce providers; how to design audits that do not penalize carriers for provider shortages; and whether required audits would increase premiums or administrative costs.
Next steps: The Insurance Department will circulate draft rules when available and the committee signaled interest in monitoring rule development before deciding legislative action.
