Health insurers’ provider directories still riddled with errors despite regulatory mandates for frequent updates

Choosing a health insurance plan and finding a medical provider can be complicated. To find health care providers in their area that are also in their insurance company’s network, consumers often rely on directories published by health insurance carriers.

After many of these directories were found to have significant errors, state and federal agencies implemented the No Surprises Act of 2021 to require insurers to verify and update directory information at least every 90 days.

Now, for the first time, researchers have assessed the act’s success and impact on consumers so far.

“Specifically, we analyzed changes to provider directories over time to see whether inaccuracies exist, any potential differences in inaccuracies between carriers and provider specialties and how the passage of time affects rates of inaccuracy,” said Simon Haeder, PhD, an associate professor of health policy and management in the Texas A&M University School of Public Health, who led the study.

The study, funded by the Insurance Department of the Commonwealth of Pennsylvania and the Robert Wood Johnson Foundation, was published in the journal Health Affairs Scholar.

For their research, Haeder and a colleague from Oregon Health & Science University conducted a pair of “secret shopper” telephone surveys of providers listed in directories published by the eight insurance carriers in Pennsylvania’s Affordable Care Act marketplace. More than 100 School of Public Health student research assistants verified whether the contact information and their specialty listed in the provider directories were correct and if the provider actually was in the carrier’s network.

In their first survey, conducted from March 30 to Aug. 31, 2023, they identified 5,453 providers that had errors in contact information, insurance network status or specialty. The researchers then resurveyed 5,170 of these providers, selected at random, between 117 and 280 days later. The second survey found that 983 of the providers from the first survey had been removed from the directories.

“We found notable differences in the proportions of inaccuracies the carriers removed, which ranged from around 35 percent to less than 9 percent,” Haeder said. “There were also differences among the different specialties, ranging from a low of 13 percent for dermatology and a high of around 23 percent for obstetrics and gynecology.”

The researchers also found that 2,316 of the listings in the followup survey had one or more inaccuracies, again with large differences between carriers, while 600 providers had accurate listings. The researchers were unable to verify information for 1,271 listings. Errors in contact information were the most common, at 36 percent, with 9.1 percent of providers having incorrect specialties listed and 3.7 percent of providers actually being out of network.

There was also notable variation in contact information, specialty and network errors between specialties. Additionally, the analysis found that inaccurate listings were more likely to be removed or corrected for every 100 days between contacts.

The researchers note a few limitations to their analysis that should be considered. First, while many of the carriers in the study offer plans in multiple states and research has found provider directory errors throughout the country, these specific findings are limited to Pennsylvania and may not be applicable to other states. The analysis also measured listing accuracy at two points in time, making it impossible to determine when directory changes actually occurred. Additionally, the survey did not measure whether there were multiple inaccuracies in the listings, which could underestimate how error-prone directories are.

“The bottom line is that inaccurate listings remain in provider directories longer than the 90-day period mandated by law,” Haeder said. “For consumers, this makes choosing plans and providers more difficult and could delay care while increasing costs.”