Kaiser Health News, citing a new California Department of Managed Care analysis, has reported that health plan directories in California are still plagued by errors. In fact, it appears that health insurers’ lists of physicians may actually be getting less accurate. The author of the state report said that 36 of the 40 insurance directories she evaluated had inaccuracies that will lead to fines.
Last summer, California introduced legislation mandating that insurers keep these directories up-to-date. The state is concerned about incorrect directories because patients rely on these listings to choose doctors who accept their coverage. Inaccuracies are hassle for consumers. Worse, if a patient inadvertently chooses a physician who is not in-network for an expensive service, the patient can end up owing a large balance.
More fines may be appropriate for the health plans who’ve failed to keep their directories current, but I’m doubtful they will improve directory accuracy — at least not immediately. Inaccurate directories have long been a problem that causes trouble not just for patients, physicians, and health systems, but for the payers themselves. The challenge is maintaining directory data when managing a directory is not you core business — as is the case with health plans.
I’ve said it before, and I’ll say it again: maintaining health plan directory data accuracy shouldn’t be the job of practices, but you nonetheless must take responsibility for it. Otherwise, you risk missing opportunities to serve patients who can’t find you if you’re improperly excluded, and you risk inadvertently seeing patients who aren’t covered when you’re improperly included.
It’s a bit labor-intensive, but reviewing and fixing directories is not difficult. I explain out to do it in my ebook and my new print book. It’s a great task to delegate to one or more staff members to work on a bit at a time during down-time.