Study: Health Plan Directories Remain Spotty Despite Legislative Intervention
By Emma Freer

Health plans continue to maintain inaccurate directories of in-network physicians and other health care professionals, despite a federal law that aims to ensure such directories are up to date. 

A new study published in the Journal of the American Medical Association (JAMA) found 81% of physician entries were inconsistent across five large national health plans’ directory data. The most common inconsistencies were between practice location addresses and physician specialties.  

Health plan directories are critical for patients seeking in-network care and to ensure adequate networks, study authors said. 

“Beyond surprise billing, inaccurate physician directories can lead to delays in care due to difficulty finding the correct physician, challenges in regulators assessing health insurer network adequacy, and misrepresentation of network depth and breadth as consumers select health plans,” they wrote. 

Previous studies have produced similar findings, but the JAMA study specifically looked at health plans’ physician directories in the wake of the federal No Surprises Act, which took effect in January 2022 and requires “insurers to maintain, verify, and update physician directories.”  

Despite these requirements, such directories remain spotty. Researchers cited several obstacles on the path toward accurate databases, including “frequent changes and lack of a uniform standard.”  

They also echoed a concern surfaced by the Texas Medical Association: that the No Surprises Act adds to physician practices’ administrative burden by requiring them “to send directory updates to insurers via disparate technologies, schedules, and formats” at a collective annual cost of $2.76 billion.  

Robert Bennett, TMA’s vice president of medical economics, says this potential burden is significant but necessary to provide accurate directories for patients as well as hold health plans accountable for inadequate networks. He also notes some Texas physicians have struggled to update their information because of unresponsive health plans. 

To address these issues, the researchers point to “unified technology-enabled solutions, such as that proposed by the Centers for Medicare & Medicaid Services [CMS], which is seeking to create a single, centralized physician directory using modern interoperable formats.” 

TMA commended CMS’ effort to create a national directory of physicians and other health care professionals in a December 2022 comment letter responding to the federal agency’s request for information.  

“[E]stablishing a well-managed, accurate, centralized directory could achieve our mutual goal of reducing wasteful spending without impacting patient care or access,” TMA Immediate Past President Gary Floyd, MD, wrote.  

But TMA also pointed to the many challenges such a project could face and advocated for physicians to be involved in the development of a national directory and compensated for their time spent testing it.  

For more information, check out TMA’s surprise-billing resource page
 

Last Updated On

June 12, 2023

Originally Published On

June 01, 2023

Related Content

Insurance

Emma Freer

Associate Editor

(512) 370-1383
 

Emma Freer is a reporter for Texas Medicine. She previously worked in local news, covering city politics, economic development, and public health. A native Clevelander, she graduated from Columbia Journalism School and the University of St. Andrews.

More stories by Emma Freer