Insurers' lists of in-network physicians often outdated

The array of in-network physicians insurers offer patients may be narrower than they seem, because the lists often include erroneous or out-of-date names or addresses, according to a recent article in The Wall Street Journal.

In some instances, physicians included on these lists have moved, retired or even died, according to the article. Others are categorized under the incorrect specialty, don't see outpatients or don't accept the plan being offered.

Insurers say physicians are obligated to keep them informed when they change locations or stop participating in plans, but many physicians say insurers aren't responsive to their complaints about inaccurate listings, according to WSJ.

The article cited one instance last year in which UnitedHealth Group cut almost 20 percent of the physicians from its Medicare Advantage networks in some states. Among those dropped were 296 physicians from the Moffitt Cancer Center in Tampa, Fla., and more than 1,200 Yale Medical School faculty members. However, UnitedHealth's Medicare Advantage provider directory for 2015 still list 16 of the cut Moffitt physicians and 40 Yale Medical Group physicians as participating in those plans, according to the article.

Similar issues have occurred in plans sold on federal marketplace exchanges. According to WSJ, California regulators released surveys revealing that more than 25 percent of physicians listed by Blue Shield of California and Anthem Blue Cross as participating in their health exchanges plans were located in different facilities than specified by the list, or the physicians denied those plans.

While insurers advise consumers to check with their physicians to see what insurance plans they accept, discrepancies such as these can be misleading.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars