Inaccurate listings muddy provider selection
November 02, 2014
Reuters reported on two studies indicating how difficult it can be to book an appointment with a doctor of a certain specialty or when using Medicare Advantage. In particular, over 15% of the doctors were not reachable via the phone numbers listed (e.g. the doctor retired or moved, or the phone number was incorrect), and between 9% and 15% of doctors were not accepting new patients. There is some speculation as to whether these directories were inaccurate because of outright neglect or whether insurance companies knowingly included incorrect listings in order to make the networks seem bigger than they actually were.
Some aspects of this seem relatively easy for insurance companies to solve. For example, they should be able to review claims and notice that a specific doctor has not submitted a claim for months and can follow up to see if that doctor should still be included in the network. Some other aspects can be harder to address: doctors might change whether they are accepting new patients relatively frequently, or they might not be accepting new patients who use a specific insurance (but might still accept that insurance for existing patients). Having an accurate and updated directory will involve effort from both the insurers and providers, and it's easy to see how both might let the project slip in the morass of other priorities. Unfortunately, patients needlessly experience frustration with outdated directories when trying to secure an appointment.