As insurers face growing criticism for giving consumers inaccurate information about their provider networks, some experts are asking whether it's really that hard to maintain an accurate provider directory.
The bad information has drawn lashes from California regulators and proposals for stricter oversight from the nation's insurance commissioners and the Obama administration. Good provider directories are critical as millions of Americans choose health plans on the Obamacare exchanges. Consumer advocates say shoppers must be able to examine their provider choices in cheaper narrow-network plans.
Insurers and consultants blame software problems, failure by providers to send updated information and the sheer difficulty of tracking thousands of doctors. There are “dozens of plans with dozens of different networks,” said Dan Schuyler, senior director of exchange technology at Leavitt Partners. “It's very difficult to keep these provider directories updated, certainly on a daily basis.”
A spokeswoman for America's Health Insurance Plans said that accurate directories are a “shared responsibility” and providers often “just aren't providing information in a timely manner.”
Josh Nelson, a vice president at Arches Health Plan in Salt Lake City, said the company's software differentiates doctors by tax ID number but doctors often use the same number across different practices. “There are a lot of cardiologists in the Salt Lake Valley,” Nelson said. “We don't want them all. But if we choose those few that operate in Park City, the system enters all the locations they practice in. It defeats the purpose of a narrow network.”
That has some experts scoffing. “These explanations are outrageous,” said veteran healthcare consultant Robert Laszewski. “Not having accurate consumer-level information about just who is in their provider network—particularly when they are using narrow networks—is inexcusable.”
The National Association of Insurance Commissioners recently revised its model law for states to require that plans update their provider directories at least monthly. HHS has proposed requiring insurers selling plans on the exchanges to indicate whether providers in their network are accepting new patients.
Lynn Quincy of Consumers Union said the exchanges themselves need to offer tools to enable consumers to readily compare provider networks when they are shopping for a plan. But Schuyler said such choice tools are tricky to set up because insurers have different ways of listing providers. HHS has proposed that plans post their provider directories in “machine-readable” files so that outside organizations can create comparison tools for consumers.
