Study: Inaccurate provider directories disrupt care access

stethoscope on piece of paper

Healthcare beneficiaries in California have just a 30 percent chance of scheduling an appointment with an in-network physician, according to a study published in Health Affairs that underscores lingering concerns about the accuracy of provider networks.

Using two “secret shoppers,” researchers at the University of Wisconsin and the University of California Irvine attempted to schedule appointments with more than 700 physicians within California. One secret shopper presented insurance coverage obtained through Covered California’s marketplace, and the other had a “mirrored plan” obtained outside of the marketplace.

Both prospective patients had difficulty scheduling an appointment with their originally selected physician. In 10 percent of instances, the physician was no longer with the practice, and in 30 percent of cases the wrong specialty was listed on the insurer’s network. In nearly 20 percent of cases, the secret shoppers were unable to reach the physician despite repeated attempts, and in 10 percent of cases the physician was no longer accepting new patients.

Although the study focused on Covered California plans, the researchers argued the findings were “indicative, if not representative of the situation in much of the country,” noting that Blue Cross of California’s parent company, Anthem, operates in more than a dozen other states. The researchers also urge more frequent directory updates and better oversight from state regulators.

Last year, the Centers for Medicare & Medicaid Services issued a new rule requiring insurers to provide up-to-date physician lists for Medicare Advantage and Healthcare.gov policies that included fines of up to $25,000 per beneficiary for any violation. And earlier this year, America’s Health Insurance Plans launched a new pilot project in three states that will test a centralized approach to updating provider directors.   

- here’s the Health Affairs study (subscription required)