How Unclear Provider Data Contributes to Unexpected Medical Bills

In 2018, 57% of Americans received an invoice for services they thought were covered by insurance, also known as a “surprise bill.” Of that group, 20% reported that these charges were the result of visiting a doctor who was not part of their insurance network.

To find an in-network practitioner, including office location, hours and contact information, many consumers rely on their health plan’s provider directory. Although much of the information they contain is submitted to the plan by the providers themselves, directories have come under scrutiny from policymakers for high error rates.

CMS has been conducting audits of Medicare Advantage online directories since 2016 and, despite concerted efforts by the industry to improve accuracy, the agency has found that nearly half of all directory information is still incorrect.

At the root of this problem is the fact that each health plan collects directory information using different methods and on varying cycles. Providers who participate in several plans face what may seem to be non-stop and inconsistent requests for updates. This can be a nuisance for busy providers and practice administrators — and a burden for the health plans who need to track them down.

As providers and plans share responsibility for keeping the information up-to-date, this is an area where an industry-wide solution — and centralized repository to help address directory accuracy — can make a big difference.

Read the Medium post to learn more.