Thinking About Health: Medicare Advantage Directories Are Full Of Outdated, Incorrect Information
•December 26, 2018•
By Trudy Lieberman,
Rural Health News Service
The other day came a lengthy report (https://go.cms.gov/2StPAIu) from the Centers for Medicare & Medicaid Services (CMS) announcing worrisome findings for anyone with a Medicare Advantage plan or anyone thinking about buying one in the future. The findings are also relevant to anyone buying any kind of health insurance this year.
The ominous takeaway? The information given to consumers in the provider directories is deeply flawed, often misleading, inaccurate, and “can create a barrier to care,” CMS said. Imagine choosing a plan based on the information stating your doctor is in the plan’s network, only to find he or she is not and you have to find a new doctor, perhaps in an inconvenient location.
Actually, finding any provider at all may be hard. CMS said that providers were not located at one-third of the addresses indicated in the provider directories. That means if a beneficiary tried to make an appointment with the doctor at a particular location, they’d be out of luck. Government researchers noted that sometimes providers did not work or accept the health plan at any of the locations listed in the directory.
Had the provider ever been part of the health plan’s network? Good question! CMS said this was a “concern.”
About half of the online directories the agency sampled had at least one inaccuracy. The directories included incorrect phone numbers, indications that a provider was accepting new patients when that wasn’t the case, and claims that providers were practicing at locations where they were not.
All these findings, of course, raise the question: Why so many mistakes given how detrimental this bad information can be to seniors? CMS investigated that, too, and found a “general lack of internal audit and testing of directory accuracy among many Medicare Advantage organizations.” The health plans rely on credentialing services and vendor support to ensure directory accuracy, which is not exactly a reliable method, the agency concluded.