New York health plans rapped over out-of-date physician directories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In response to complaints from patients who were frustrated by out-of-date physician directories, New York Attorney General Eric Schneiderman has ordered a group of health plans to improve their listings and pay back patients who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