California regulator report reveals insurers' flawed network lists

Dive Brief:

  • A recent report from the California Department of Managed Health Care found 90% of reporting health plans in 2015 submitted inaccurate data or did not follow the required methodology in their timely access compliance reports submitted to the state agency.
  • Among insurers with high error rates were Aetna, UnitedHealthcare and Cigna.
  • For example, 8,572 providers on one Cigna list were not on the other, a discrepancy of 36%, California Healthline reported, adding UnitedHealthcare had a 45% discrepancy between its two lists, with 8,572 providers listed as in-network during the year but not in the year-end list.

Dive Insight:

The discrepancies were revealed during a review of insurers’ annual reports, which require plans to submit both the provider list used during the year and a year-end tally. The extent of inaccuracies makes it “virtually impossible” to determine health plan compliance and compare plans across the industry, the report noted. 

The plans could face penalties. In 2015, Blue Shield of California and Anthem Blue Cross paid the state $350,000 and $250,000, respectively, for inflating their provider networks.

Inaccurate provider lists can impede patients getting timely care or result in unexpected out-of-pocket costs if patients inadvertently get out-of-network care. They also make it harder for consumers to shop around and compare health plans with any degree of certainty about what they are comparing.

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Filed Under: Payer Policy & Regulation
Top image credit: Wikimedia; Optigan13