California Regulator finds inaccurate provider lists

When consumers select an insurance plan, provider networks can be an extremely component of that choice. Among other questions, consumers may want to know "does my long-time doctor accept this particular insurance plan?" or "if I choose this plan, will I be able to find a specialist who is available to treat my condition?" To the extent that health insurance plans are differentiated from one another on factors other than price, provider networks are an important component of that differentiation. Therefore, misrepresentation of provider networks can be compared to false advertising. California Healthline reported that the director of the California Department of Managed Health Care found that 36 out of 40 insurers that were reviewed may be fined for submitting inaccurate provider network data.

Interestingly, insurers submit two lists to the state of California: one for evaluating patient access, and one for a year-end tally. The article seems to imply that the first list often exceeded the second list (by 45% for primary care doctors for one insurer, and by 50% for specialists for seven insurers). If true, those discrepancies are material and significantly affect how attractive a particular plan is. I'm glad that someone in government is trying to hold insurers accountable for the provider networks that they publish.