AMA House of Delegates

AMA meeting: AMA collecting complaints on insurer directories

Doctors say insurance plans often fail to update physician listings.

By Pamela Lewis Dolan — Posted July 16, 2007

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Physicians can drop an insurance plan, move, retire, change practices or even die, and their information will remain the same in the insurer's directory, say doctors who are fed up with the inaccuracies in insurance plan physician directories.

At its Annual Meeting, The AMA House of Delegates approved a resolution calling for the Association to solicit and compile complaints by members regarding inaccuracies contained in health plan directories.

The House also resolved to have the AMA collect the physician complaints and make them available to members upon request.

Board Trustee Peter W. Carmel, MD, a pediatric neurosurgeon from Newark, N.J., said when inaccuracies occur, "it places physicians at a disadvantage when his area of expertise is not listed or is not correct."

"We believe these inaccuracies are financially mandated by the insurers ... to show they have a larger spectrum of providers than they actually do," said Peter Kaufman, MD, a gastroenterologist from Bethesda, Md. He said the inaccuracies have caused gastroenterologists serious problems when patients seek out specialists, and the physician's specialty is not listed or is wrong.

Dr. Kaufman went on to say he has seen physicians listed in directories up to two years after they have died.

AMA policy states health plans "must promptly remove the physician's name from marketing materials and directory of participating doctors upon termination of that physician's contract with the plan."

But many of the inaccuracies occur when group practices sign multiyear contracts, and the groups do not inform the plans when someone leaves mid-contract, said Mohit Ghose, spokesman for America's Health Insurance Plans. "We would encourage physicians to provide timely updates. I really don't think this has anything to do with intentional misrepresentation for marketing purposes."

The AMA policy also states plans should make the directories available through multiple media sources, including the Internet. Many have, according to Ghose. He said many directories have gotten better since going online, which made it possible for changes to be made as soon as a physician's status within the plan changed.

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ADDITIONAL INFORMATION

Meeting Notes: Medical practice

Issue: Insurers have implemented policies to fine physicians when patients chose to use out-of-network services.
Proposed action: "Vehemently oppose" any penalties insurance companies use against doctors when patients independently use out-of-network services. [Adopted]

Issue: The time psychiatric patients spend in emergency departments is steadily increasing, exacerbating ED crowding issues.
Proposed action: Work with other stakeholders to study the issue and develop recommendations regarding the national scope of the psychiatric bed shortage problem and its impact on the nation's emergency and general medicine resources, including ED overcrowding. [Adopted]

Issue: As more physicians move toward adoption of health information technology, they find the buying decision challenging because so many options are available.
Proposed action: Use the AMA Web site and Association publications to educate physicians about issues to consider when purchasing health information technology systems, including ensuring that there is adequate technical support. [Adopted]

Issue: Health care spending continues to rise more quickly than wages and inflation.
Proposed action: A host of strategies, including reducing preventable disease, improving efficiencies in health care delivery, reducing nonclinical costs that do not add to the value of patient care and improving health-related decision-making processes. [Adopted]

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