Health Care Professionals Call for Standardized Provider Directories
Inaccurate health care provider directories cause stress, unnecessary expense, and aggravation for insurance customers every day, according to witnesses testifying before a Senate Committee on Finance hearing on May 3.
“Ghost networks are an ongoing, persistent problem,” said committee chairman Sen. Ron Wyden (D-Ore.)
Witnesses called on Congress to take steps to standardize directories and hold insurance companies accountable for the issue.
Ghost networks are formed when a health insurance plan’s directory includes inaccurate information, such as listings for doctors who have retired, never worked for the listed office, or are outside the plan’s network.
Wyden said this often becomes apparent only after a customer has enrolled in the plan. His staff did a “secret shopper” survey of health plans and successfully booked an appointment 18 percent of the time. Wyden said one staff member was connected with a high school health office.
“In my view, it’s a breach of contract,” Wyden said. “The last thing [customers] need from an insurance company is a symphony of ‘please hold’ music.”
Keris Jan Myrick told the committee she has personal experience with the frustration that a ghost network can provoke.
Myrick is vice president of partnerships for Inseparable, an organization that advocates for improving mental health care policy. During the Obama presidency, Myrick was a director in the U.S. Health and Human Services’ Substance Abuse and Mental Health Services Administration.
When she moved from Los Angeles to Washington, Myrick consulted her health plan’s directory to find a new psychiatrist. She described the experience as searching for a needle in a haystack.
Plenty of Hay, Few Needles
“Lots of hay, very few needles. Unfortunately, my experience is not unique,” Myrick said.
Myrick, who requires treatment for schizophrenia, said that when she finally found a psychiatrist in Washington who was taking new patients, she was told that the doctor didn’t treat schizophrenia.
She was forced to make monthly trips back to Los Angeles to continue seeing her original doctor. Myrick told the committee that people with her illness but without resources could expect to deal with homelessness, the criminal courts, and other problems.
“The consequences are dire,” she said.
While the ghost network problem is most prominent in the mental health care sector, Dr. Jack Resneck, president of the American Medical Association, said it affects the entire health care industry. Resneck said it is a problem that requires government intervention.
Standardization Is Key
“Achieving directory accuracy is not simple,” Resneck told the committee.
He said each plan has its own system for updating directory information. So, if a doctor is listed in a dozen health care networks and makes a change, his staff must update each directory. Even when they do that, there is no guarantee that the changes will be made.
Resneck said a strong regulatory system would restore consumer confidence in a health care system that can’t help them find a doctor.
“Enough is enough. We can fix this,” Resneck said.
Dr. Robert Trestman, of the Carilion Clinic and Virginia Tech Carilion School of Medicine in Roanoke, Virginia, agreed. As chair of psychiatry and behavioral medicine, he serves a largely rural area, so finding a doctor can already be a challenge. Dealing with a ghost network can be especially difficult for someone with a mental illness.
Process Is Demoralizing
The inability to find a doctor who will see them can make the prospective patient feel like the issue is his fault.
“The process, at best, is demoralizing,” Trestman said.
On top of all this, Mary Giliberti, of Mental Health America, in Alexandria, Virginia, said there is little incentive for health plans to address the issue.
Some plans intentionally inflate their directories to make it appear they have more extensive networks than they do. Health insurance providers face no real consequences for this practice, Giliberti said.
She said her organization found that two-thirds of the listings in directories they studied needed to be more accurate.
Customer on the Hook
Consumers who see an out-of-network provider are responsible for the total cost of their care. It doesn’t matter that they relied on an inaccurate directory to find that doctor.
Giliberti said this is not fair.
“Why should the patient be on the hook here? It should not be the responsibility of the individual,” she said.
Giliberti and other witnesses recommended a “carrot and stick” solution. Providers that kept accurate directories would be rewarded, while those that did not would be penalized. The witnesses called for three main elements in any plan, oversight by regulatory authorities, transparency in the process, and accountability.
Dr. Jeff Rideout said his organization had developed such a system. He believes it can be expanded.
Rideout is with Oakland, California’s Integrated Healthcare Association (IHA). He said IHA had developed a system named Symphony. Health insurance plans in the Symphony system place their directory information in a central repository. The programs are required to update their entries when necessary.
The system automatically audits the directories every 90 days. Symphony will make corrections that it can and notify members when changes must be made that Symphony cannot make.
Rideout said developers are constantly updating Symphony by adding data categories to help consumers find the needed doctors and health care providers. He said that having the central repository makes the job easier.
Still, Rideout conceded that maintaining the system is a “complex undertaking.”
