Pennsylvania Insurance Department Releases Comprehensive Study on Health Insurer Provider Directories, Aiming to Improve Healthcare Access for Pennsylvanians

​Pennsylvania Insurance Commissioner Michael Humphreys to work with stakeholders to address inaccurate health insurer directories

Harrisburg, PA - To improve access to healthcare services across the Commonwealth, the Pennsylvania Insurance Department (PID) today released the results of a study on the accuracy of health insurer provider directories. This data, one of the first of its kind collected by any state, shines a light on persistent inaccuracies in provider directories that can delay care, hinder scheduling, or result in surprise out-of-network charges.

By law, insurers are required to maintain up-to-date, accurate provider directories that list healthcare professionals, hospitals, and clinics in their networks. However, when these directories are inaccurate, people are often left to navigate misinformation that impacts their access to timely, in-network care. With provider directory inaccuracies becoming a widespread issue nationwide, PID initiated this study to gather Pennsylvania-specific data and better understand the extent of the problem. The study analyzed the provider directories of all insurers operating in Pennsylvania's Affordable Care Act (ACA) Marketplace, uncovering consistent inaccuracies that impact consumers and highlighting the need for targeted reforms.

The study included a survey of nearly 7,000 healthcare providers listed in Pennsylvania's ACA Marketplace directories, revealing that these inaccuracies often persist over time and fall short of requirements under recent federal law. Findings include:

• Only 13 percent of the surveyed provider listings had accurate contact information;
• Up to 44 percent of providers were unreachable due to incorrect information; and
• Substantial differences in accuracy were noted between carriers, with some variations by provider specialty as well
  

The inaccuracies in these directories create significant challenges for consumers seeking in-network care and diminish the effectiveness of regulatory oversight efforts. The most common inaccuracies involved outdated contact information and incorrect specialty listings, which can mislead patients and lead to care delays and unexpected charges.

"Insurance company provider directories must be accurate - full stop," said Pennsylvania Insurance Commissioner Michael Humphreys. "This report reveals a troubling picture of the doctor lists that Pennsylvanians rely on to find in-network providers and schedule medical appointments. It provides us with clear opportunities to make meaningful improvements. By working together with stakeholders, we can make significant progress and make it easier for consumers to find active, in-network care."

With this data, PID aims to work with insurance providers and healthcare stakeholders to address these issues. The department will initiate stakeholder outreach to gather input and develop solutions that reduce inaccuracies in provider directories, helping to ensure Pennsylvanians have reliable information about in-network healthcare options.

Two additional reports on network adequacy, funded through a grant from the Centers for Medicare & Medicaid Services (CMS), will be released in the coming weeks, further supporting PID's commitment to building a more accessible, transparent healthcare system.

This initial study was conducted from June 2022 to January 2024 with funding support from CMS's State Flexibility Cycle II Grant Program. This project was partially funded by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) State Flexibility Cycle II Grant Program. The total cost of the project was $1,445,775. The State Flexibility Cycle II Grant Program provided 23 percent of the funding for this project. The remaining 77 percent of funding for this project, or $1,112,725, was funded by non-government sources.

Pennsylvanians with questions or issues related to their provider directories can contact the PID Consumer Services Bureau online or by calling 1-877-881-6388.

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