(215) 567-3500

Call Us, We Can Help.

Health Directories Far From Accurate

By: Cohen, Placitella & Roth @ Jan 23, 2017

Regardless of the type of health insurance that you carry, one thing is for sure: it is important to know which doctors are – and are not – covered under your plan. What’s more, many people make decisions about which type of healthcare to purchase during the federal open enrollment periods based on which doctors are available under each plan type.

You Need to Know If You’re Covered

In order to learn whether or not a certain doctor is covered under a certain insurance plan, most patients use an online directory. The online directories – which are sponsored by the healthcare insurance providers themselves, such as Anthem – work by asking you which plan you have, and what type of doctor you are looking for and where. Then, a list of doctors in your network pops up, and you can view their specialties, location, and whether or not they are accepting new patients.

The bad news is, though, that these online directories are so poorly managed that, more often than not, the information is completely inaccurate.

How Inaccurate is Inaccurate?

Very inaccurate. In fact, according to an article in The New York Times, one patient found that only 15 percent of doctors who were listed in an online directory as “accepting new patients” actually were. Another patient had to call 17 different doctors who were listed as accepting his marketplace health insurance plan before finding one who actually did.

What Does This Mean for Patients?

The fact that online healthcare directories are so poorly maintained means a few things for the patients who rely upon them.

First, it means that patients who are changing doctors or healthcare plans and are looking for new physicians may be unable to find one with ease. In fact, it could take dozens of hours’ worth of phone calls to find a doctor who is even accepting new patients, let alone accepting one’s plan.

Second, it may mean that patients get stuck with health bills that they didn’t think they would owe. Consider a situation where a patient believes the dermatologist they are seeing is covered by their insurance plan, as the doctor was listed as a covered dermatologist in the insurer’s directory. Later, though, the patient receives a bill for hundreds of dollars, with a note explaining that the doctor was not, in fact, covered.

Third, as more patients learn that the directors are not serving their needs, they may feel discouraged by the system and frustrated, choosing to not seek much-needed medical care at all rather than attempt to navigate a broken system.

We Care About Patient Services

At the law firm of Cohen, Placitella & Roth, P.C., our medical malpractice attorneys are interested in the future of healthcare. We hope that, at the very least, patients are able to use directories that are accurate, and penalties for inaccuracies are enforced.

If you are seeking healthcare with a new doctor or under a new health insurance plan, we urge you to call the doctor and your insurance company to ensure coverage before you go.

Site by: