Directories not only failed to list in-network providers, they also listed out-of-network providers as in-network and contained incorrect information for the in-network providers they did list. (Image: Shuttesrtock)
If you think your health insurance plan provider directory is only a few steps up from useless, you could be right: a recent study has found that health plan participants seeking out providers from directories at those health plans would be better off looking for provider information on Google.
The study, published in the American Journal of Managed Care, looked at the accuracy of plan provider directories over a five-county area, utilizing data from the CMS, Medicare Advantage directories, machine-readable health insurance directories, and Google Places.
The findings? Directories not only failed to list in-network providers, they also listed out-of-network providers as in-network and contained incorrect information for the in-network providers they did list.
So all those complaints from plan members about directories have a sound basis in fact—says the study, "Without accurate provider information, plan members cannot navigate their plans successfully, regulators cannot ensure plans meet requirements, and researchers have no accurate source of provider information."
In fact, although the term "reasonable access" is actually mandated by the Affordable Care Act, plan members don't necessarily get it, since the term is not defined by federal regulations. And regulators measure access differently, depending on whether the directories being evaluated are judged by national standards in MA plans or by "individualistic network access plans in several states."
CMS has reported that 52 percent of MA plan directories have at least one error, but the numbers are more frightening than that: researchers were able to confirm 73 percent of providers' address information listed on Google Places, but only 72 percent for MA directories; CMS' NPPES file came in at 67 percent and MR health insurance exchange directories at 65 percent.
Researchers also found conflicting information in the directories, writing, "We found that provider directories from insurers with MA and exchange plans did not report the same phone number 50 percent of the time and did not list the same address 31 percent of the time."
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Marlene Satter
Marlene Y. Satter has worked in and written about the financial industry for decades.
