Dive Brief:
- Health plans may not be doing a good job of updating their lists of in-network physicians, often leaving incorrect or out-of-date names and addresses on the rolls, according to The Wall Street Journal.
- The incorrect in-network information health plans offer may include doctors who have moved, retired or died; others don't see outpatients, don't accept that plan or don't practice the specialty under which they are listed.
- The WSJ article notes that in one example, UnitedHealth Group cut nearly 20% of physicians from its Medicare Advantage networks in some states, including almost 300 physicians from the Moffitt Cancer Center in Tampa, FL and over 1,200 Yale Medical School faculty members. However, its provider directory for its 2015 Medicare Advantage plan still lists Moffitt and Yale doctors.
Dive Insight:
When is a narrow network not a narrow network? When a health plan only does business with a modest number of providers but leaves additional providers on its in-network list. Padding its lists for PR reasons is just one of several potential motives health plans might have for not keeping their in-network doctor list fresh. They may also be publishing inaccurate information simply because it's the patients and doctors, not the health plan, who are inconvenienced or even damaged financially when a patient relies on out-of-date listings.
Whether or not health plans have nefarious motives for letting their network lists become inaccurate, it's an unfortunate situation. This is clearly a practice that adds friction to a system already replete with inefficiency. The federal government may wish to take an interest in assuring that patients can rely on the network lists shared by health plans, and where Medicare Advantage is concerned, probably has the power to do so already. While patients do have a responsibility to double-check these listings, giving payers a push in the direction of network list accuracy is probably a good idea.