As health advocates continue to hear stories of consumers who can’t find care in their network, AB 280 (Aguiar-Curry) would finally hold health plans accountable to keep their provider directories up to date SACRAMENTO, CA – As the problem of inaccurate health plan provider directories persists in California, Majority Leader Aguiar-Curry took on the cause […] The post Legislation Introduced to Ensure Accurate Health Plan Provider Directories appeared first on Health Access.
As health advocates continue to hear stories of consumers who can’t find care in their network, AB 280 (Aguiar-Curry) would finally hold health plans accountable to keep their provider directories up to date
SACRAMENTO, CA – As the problem of inaccurate health plan provider directories persists in California, Majority Leader Aguiar-Curry took on the cause today with the introduction of AB 280. This new bill will help California health consumers make sure that when they go to find a provider in their plan’s network or shop for a new health plan, that the listings are up to date.
Health advocates for years have heard stories from patients frustrated by searching through often outdated and inaccurate “ghost” provider listings from their health plan. Wrong numbers, providers who are not taking new patients, and some listed who no longer practice, still often show up on these directories, making it harder for patients to find the care they need – leading to worsening health outcomes.
While existing law has required these listings to be accurate for over a decade, it has not been effective enough. AB 280 requires that health plans annually verify the information in their provider directories and sets accuracy benchmarks to enforce existing law. These annually increasing accuracy benchmarks will require that health plan provider directories be 95% accurate by 2029. These requirements seek to improve and maintain provider directory accuracy for consumers, so that they can find the care and coverage they need when they need it.
“When people sign up for a health plan, they should be able to reasonably expect that most of the health professionals on the list are available to provide care. People should be able to trust their health plan directories to have doctors and mental health professionals who can give them the care they need in the time they need it,” said Majority Leader Cecilia Aguiar-Curry. “This bill will make sure that when you’re shopping for a health plan, you’re not basing your decision on a ‘medical mirage,’ a list of providers who are out of business or not taking patients.”
“Patients shouldn’t have to navigate a maze of incorrect information just to find someone to treat them,” Aguiar-Curry emphasized. “This legislation provides a roadmap to improve transparency and accountability, making our healthcare system work better for everyone.”
“Health plan provider directories are crucial for consumers to find the care they need in their network. But these listings are often so grossly inaccurate, it’s difficult or nearly impossible for someone to find that care,” said Katie Van Deynze, Senior Policy and Legislative Advocate with Health Access California. “This leads to delays in needed care, which can worsen existing health conditions. AB 280 puts health plans on a path of improvement, and holds them accountable to keep these directories up-to-date for consumers, so they can find care. We thank Majority Leader Aguiar-Curry for her leadership on this important issue.”
Existing law, SB 137 (Hernandez, 2015), requires the inclusion of basic contact information for providers listed, regular updates by health plans and an annual review by the regulating department. It also mandates that if a consumer visits a provider listed as in-network by their plan’s directory, but the provider turns out to be out-of-network, the consumer is only responsible for paying their in-network cost-sharing. However, this law has not ensured the accuracy of these directories.
In fact, one health plan was found to have an error rate of 80% for psychiatrists with most having error rates of 20%-30%. Error rates vary among health plan directories but are highest for non-physician mental health professionals and psychiatrists; error rates are also high for primary care and specialty care providers. These inaccuracies have the greatest impact on consumers who already face the worst access, such as those with limited English proficiency, persons with disabilities, and others in marginalized communities thus worsening inequities in health care.
Health Access has collected numerous stories of patients frustrated with ghost networks and inaccurate provider directories. As Susan F, of Santa Ana, said, “When you tell a Blue Shield representative about [inaccurate provider listings], they say, ‘well, call us back with the list that you have of doctors that are not calling you back or not taking new clients or are no longer in the network and let us know.’ Why do we, [the consumers] have to do the leg work?”
By establishing mechanisms of accountability and streamlining the process, AB 280 will take this burden off the consumer, and improve the accuracy of health plan provider directories across the state, ensuring that consumers can rely on directories to find the care they need.
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Press inquires can be directed to:
Rachel Linn Gish, rlinngish@health-access.org, (916) 532-2128
The post Legislation Introduced to Ensure Accurate Health Plan Provider Directories appeared first on Health Access.
