a health care explanation of benefits notice

Many employers are turning to value-based care this year as costs continue to climb. However, provider directories that often include inaccurate addresses, phone numbers, specialties and availability can frustrate their efforts to provide efficient, affordable health care.

“The extent of these inaccuracies is staggering,” according to research from Garner. “Our data suggest that only 27% of the time health plan directories contain the accurate information needed to reach a provider. As employers add plan designs that include more directed steerage, the accuracy of these directories will become an increasingly important issue.”

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Previously, broad network health plans allowed employees to find a doctor using any method they preferred, such as a referral from a friend, searching online or even dropping into an office they drove by. By contrast, value-driven solutions all have a benefit design that steers members to a certain subset of providers. Many members of these plans spend hours first finding a doctor who meets their needs and then calling to validate the network status or copay levels. 

As employers deploy these solutions to their employees, this shift is exposing critical weaknesses in this foundational component of health care infrastructure:

  • Only 11% of members consult their health plan directory when selecting providers
  • Most rely on word-of-mouth recommendations or general internet searches.
  • This figure surges to 64% in value-driven plans, where choosing the right provider directly affects out-of-pocket costs.
“The scope of the problem is large, and solving it isn’t easy,” the report said. “Approximately 15 million provider-address combinations are listed in insurance directories nationwide, each requiring continuous validation across multiple data points. With providers frequently changing locations, the problem has persisted for years.”

Compounding this issue, most insurance directories include only 23 specialties, far fewer than the 82 subspecialties employees often need to access. This limitation transforms what should be a straightforward provider search into a time-consuming trial-and-error process. For example, an employee who needs to see a provider who specializes in a specific hearing issue will find it frustrating to use a directory in which the search results provided are full of generalist ear, nose and throat providers who cannot treat their issue.

The transition to value-driven health care represents more than a simple plan design change; it requires a fundamental rethinking of how employees navigate their health care journey, according to Garner.

“Benefits leaders must recognize that the success of value-driven plans depends on employees’ ability to identify and access high-quality providers,” the study report concluded. “Failing to address this issue risks further alienating employees from care. As health care costs continue their upward trajectory and employers navigate the transition to value-driven plans, the quality of their provider directory infrastructure will increasingly dictate their ability to deliver on the promises of cost control, care quality and accessibility.”

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Alan Goforth

Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.