Directory Assistance: Maintaining Reliable Provider Directories for Health Plan Shoppers

Sep 25, 2015
Inaccurate provider directories can lead to consumer frustration and confusion, and result in substantial out-of-pocket costs for consumers who may unintentionally seek and receive out-of-network care. Yet it has proven challenging for organizations -- carriers, state Medicaid agencies, and ACA-created insurance marketplaces -- to maintain accurate and up-to-date provider directories. This report examines policy, operational, business, and technical obstacles to well-functioning, integrated provider directories and how they have been overcome in four states: Colorado, Maryland, New York, and Washington. It details the perspectives and experiences of consumer advocates, carriers, providers, state-based marketplaces (SBMs), and state Medicaid agencies in those states, with the goal of informing California policymakers and stakeholders as they seek to improve consumer access to accurate provider network information.
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