HARRISBURG, PA — The Pennsylvania Insurance Department (PID) has unveiled the findings of a comprehensive study addressing the accuracy of health insurer provider directories. This initiative marks one of the first state-specific explorations into a growing national concern—incorrect provider listings that hinder access to timely healthcare services and can lead to unexpected medical expenses.
In accordance with legal requirements, health insurers must maintain precise and current provider directories, listing all healthcare professionals and facilities within their networks. However, persistent inaccuracies in these directories have emerged as a significant obstacle, delaying care, complicating scheduling, and occasionally resulting in surprise out-of-network charges. Recognizing the critical nature of this issue, PID embarked on the study to assess the situation within Pennsylvania’s Affordable Care Act (ACA) Marketplace.
The study’s extensive survey encompassed nearly 7,000 healthcare providers listed in the ACA Marketplace directories of the state. The results revealed a disconcerting level of inaccuracy:
- A mere 13 percent of provider listings contained accurate contact details.
- Up to 44 percent of providers were uncontactable due to outdated or incorrect information.
- Variations in accuracy were notable not only between different insurance carriers but also across various medical specialties.
These discrepancies pose significant challenges for consumers attempting to secure in-network healthcare, undermining the effectiveness of existing regulatory measures. Predominant inaccuracies included obsolete contact details and erroneous specialty listings, which mislead patients, causing delays and unforeseen financial burdens.
“Insurance company provider directories must be accurate — full stop,” asserted Pennsylvania Insurance Commissioner Michael Humphreys. “This report reveals a troubling picture of the doctor lists that Pennsylvanians rely on to find in-network providers and schedule medical appointments. It provides us with clear opportunities to make meaningful improvements. By working together with stakeholders, we can make significant progress and make it easier for consumers to find active, in-network care.”
Armed with this data, PID is committed to collaborating with insurance companies and healthcare stakeholders to address these discrepancies. The department plans to initiate outreach efforts to gather insights and formulate strategies aimed at diminishing inaccuracies in provider directories, ensuring Pennsylvanians have dependable access to in-network healthcare information.
Supporting PID’s commitment to enhancing the healthcare landscape, two forthcoming reports on network adequacy, funded by the Centers for Medicare & Medicaid Services (CMS), will be released. These reports will further assist in building a transparent and accessible healthcare system in Pennsylvania.
The study, conducted from June 2022 to January 2024, received partial financial support from CMS’s State Flexibility Cycle II Grant Program, which covered 23 percent of the $1,445,775 project cost. The remaining 77 percent was funded by non-government sources, reinforcing the collaborative effort to improve healthcare accessibility and transparency.
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