New York Times reporter Robert Pear briefly describes the Department of Health and Human Services’ push to fix issues found within consumer complaints. One of the major complications in the implementation of the Affordable Care Act is the inaccurate provider directories of insurance companies. Several studies have been conducted to determine that accuracy of provider directories offered through state marketplaces. In June of 2014, the Mental Health Association of Maryland (MHAMD) performed a study to assess the accuracy and adequacy of the psychiatric networks of the 2014 Qualified Health Plans (QHP) sold through the Maryland Health Connection. The results show that 57% of the 1154 psychiatrists were unreachable- many because of nonworking numbers or because the doctor no longer practiced at the listed location. Inaccurate provider directories are an issue for consumers and providers. Providers need to have an accurate provider directory so that they can refer their patients to specialists when necessary. With information like that provided in these studies available, federal government officials are now requiring insurers to update and correct their directories once a month with the status of whether the provider is accepting new patients, location, contact information, specialty medical group and institutional affiliations. Insurance companies claim that the accuracy of the provider directories relies on the information reported by providers; therefore, providers and insurance carriers must work collaboratively. If the providers and insurance carriers do not maintain accurate directories, the insurance carrier will be subject to a fine. The fine is $100 per person affected by the inaccurate directory. The provider directory regulations are not only for Qualified Health Plans but also for Medicare Advantage Plans.
The second issue that many consumers have reported is the unexpected costs associated with their plans. Mr. Krughoff, the Consumers’ Checkbook president, believes one of the reasons why individuals are surprised with their annual out-of-pocket costs is because of the way the plans are listed on the marketplace website. Plans are listed from low to high premium costs which may distract consumers from looking at other out-of-pocket costs and the plan’s actual coverage. A possible solution is the addition of annual plan costs calculator to the federal and state marketplace websites. The addition of the calculator will allow consumers to think about the plan’s premium, deductible, copayments, and prescription drugs. The state of Illinois has an online tool to assist consumers with plan comparisons. We hope that the insurance carriers and providers will work together to make sure consumers are able to use their coverage effectively.
Contact us if you need assistance accessing behavioral health treatment through your insurer or you are encountering road blocks with your insurer.