Insurers with inaccurate provider directories
April 09, 2023
Selecting a doctor from an insurance directory can be a difficult task. Many times, directories lack the information that one might want in selecting a provider. Kaiser Health News published a piece that opened with a vignette of a patient encountering incorrect information on an insurer's provider directory. The one piece of information that people would most expect an insurer's provider directory to get right is whether that provider accepts the insurer's plans. Yet, an insurance agent observed "The thing that shocked me was how many offices told my clients, 'We have never heard of this company." When asked for comment, the insurer wrote that their network "meets or exceeds regulatory standards." It is unclear whether those standards would have been met if the directory were completely accurate.
The inability for an insurer to secure enough providers may sometimes be a reflection that that insurer is not offering competitive enough rates. Since network adequacy is a concern and patients should not have to call providers' offices to sort out network status, the government should probably impose stiffer penalties for incorrect network status information. Insurers might protest about the additional cost of keeping their directories up-to-date, and perhaps this would be an opportunity for a marketplace (perhaps sponsored by the federal government) to offer each provider a single account to easily specify contact information and whether he or she accepts a variety of insurance plans. That information could then be made publicly available so that others can streamline certain functions such as identifying a suitable insurance plan for those who already have specific providers in mind.