Continuing problems with provider directories
by jerry on August 01, 2022
Kaiser Health News published an article about inaccurate provider directories hosted by health insurers. The problems with accuracy in provider directories are not new; they have been enough of a problem that state and federal regulations have been crafted to address the problem. However, as this article points out, provider directories are still plagued by inaccuracies.
The article helpfully explores some of the challenges that insurers face when trying to maintain their directories: providers might not prioritize responding to insurers' inquiries, allowing the insurers' information to get out-of-date. Although some third-parties have offered centralized solutions, this particular problem seems like it could be better addressed by the federal government. The federal government could implement a digital service that allows medical groups and individual providers to log in and declare which insurance networks they are part of, and that information can be published openly (similar to how the National Provider Identifier registry is published). Providers could be required to accept the consequences of their declarations such that if they accept a specific insurance plan, they cannot later then expect out-of-network rates for that plan. There could be unfortunate side effects like providers simply declaring themselves as not accepting any insurance plans, but that could likely be solved by fining insurers who offer plans without adequate coverage (measured in part by the number of providers who have declared that they accept their insurance plans). Since this information is used by multiple parties (including insurers and patients), it seems to make sense to centralize the functionality into a federal platform.