business

New York health plans rapped over out-of-date physician directories

In some cases, patients paid out-of-network fees to doctors who were actually part of a network.

By Emily Berry — Posted Feb. 6, 2012

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

In response to complaints from patients who were frustrated by out-of-date physician directories, New York Attorney General Eric Schneiderman has ordered a group of health plans to improve their listings and pay back patients who were unexpectedly faced with paying out-of-network rates.

The Medical Society of the State of New York "views this action by the AG favorably," said Moe Auster, the association's vice president for legislative and regulatory affairs. He said MSSNY members adopted a resolution in 2010 calling on the state to require insurers to make timely updates to their directories and penalize insurers for inaccurate listings.

Three companies signed the agreements on behalf of their New York subsidiaries: WellPoint, EmblemHealth and UnitedHealth Group. The companies did not admit or deny wrongdoing, but agreed to take steps to ensure their online directories are up to date. Each company is to pay $30,000 to the attorney general for investigative costs. The total owed to patients is being compiled. Physicians are not being asked to audit charges or refund any payments received.

They will have to review their entire networks to confirm network participation and verify listed information for every physician and other health care professional listed. The companies also will be responsible for ensuring that any companies renting their networks have up-to-date information for participating physicians.

Following that first check, the companies will have to send annual notices to every physician to make sure they are listed correctly. The companies also will have to hire auditors to verify their work and take additional measures to fix the listings if the accuracy of the directories falls below 95%.

The actions came as a result of consumer calls to the attorney general's health care hotline, prompting "undercover surveys" of the insurers' directories, said Michelle Duffy, a spokeswoman for the attorney general's office.

The companies involved released statements reiterating their commitment to giving members the most up-to-date information possible.

Sally Kweskin, a spokeswoman for WellPoint subsidiary Empire BlueCross BlueShield, said the company relies on its physicians to update their information.

"We have thousands of providers with frequent changes to their contact information, additions or retirements from their practice offices, or their participation in various plans, and we rely on providers giving us the most up-to-date information so we can keep our directories as current and accurate as possible," she said in a statement. "Those challenges, aside, we strongly support the improved and more frequent processes cited in the AG's release and have already begun implementing changes not already in place,"

Most health plans aren't usually seeking out address changes or other updates to their directories, said Stephanie Rose-Belcher, vice president of payer solutions for Enclarity. The company offers to help insurers update their listings rather than wait for a customer to complain or a physician to call with a change of address.

"These health insurers have thousands upon thousands of providers they're managing data for," she said. "They don't go looking for it. They wait to be told."

For their part, physicians and their staff are pulled in so many directions that unless failing to update an address has an immediate financial impact, they may not get to it, she said.

"The solution really is finding a universal source that can be relied upon to watch and support the update of that information," she said.

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn