California auditor finds insurance directories inaccurate
June 19, 2015
The California State Auditor issued a report faulting the state of California for not verifying network information provided by health insurance companies. Part of the state's regulatory function is to help ensure that health insurance plans have a wide enough network of doctors that plan participants can get sufficient care. The report highlights some dysfunctions of the state government (including an antiquated computer system at the ombudsman's office that "crashes" under the load of incoming complaints), but what is particularly interesting to me about the report is how some provider directories are riddled with errors, even though they were provided by insurance companies.
The auditor sampled three provider directories in three different counties, and found that one directory had inaccuracies in 23% of the profiles that they verified. Ironically, the error rate seems to correlate with the size of the insurance company. The smallest insurance company that was sampled was noted as sending out people to each doctor's office between eight and ten times a year to verify information.
Provider directories seemed to have been an area of neglect on the part of many insurance companies for a long time. The federal government is considering changes that will require insurances companies to update their directories more frequently. It seems it would behoove insurance companies to band together to form a service that offers doctors an easy-to-use centralized interface to update contact information, as well as plan acceptance status.