The Obama administration will seek to address two of consumers’ top concerns about coverage purchased through the Affordable Care Act’s exchanges — that doctor directories are inaccurate and that patients are hit with unexpected bills for costs not covered by insurance, the New York Times reports.
Addressing Complaints About Directories
According to the Times, many consumers and physicians have complained about inaccuracies in exchange plans’ doctor directories since the exchanges launched in fall 2013. Further, federal officials have said that inaccurate directories could be a sign of larger issues, such as consumers’ problems accessing covered services and insurers failing to meet federal “network adequacy” standards. For example, inaccurate provider directories could mean providers face difficulty referring patients to in-network specialists.
In response to the directories issue, federal officials said they will require insurers to update their provider directories at least once monthly. Insurers that do not do so would face financial penalties.
Addressing Complaints About Out-of-Pocket Costs
Meanwhile, federal officials hope to offer an “out-of-pocket cost calculator” to help consumers avoid surprise out-of-pocket costs. The calculator would account for:
- Copayments
- Deductibles
- Premiums
- Subsidies
- Other out-of-pocket costs and
- Individual information, such as age and medical needs.
The new rules would strengthen an earlier measure that required insurers to publish directories online and provide paper copies when requested. On the federal exchange, violators face a $100 penalty per day per person adversely affected.
Federal officials also said they might link HealthCare.gov to an out-of-pocket calculator this year. Some state-operated exchanges are developing similar tools, according to the Times.
Challenges for Insurers
Insurers have said fixing the directories might not be easy and that physicians are partially responsible for the issues. America’s Health Insurance Plans in a letter to the Obama administration said insurers “are unable to guarantee the accuracy of the provider’s status” in a directory because physicians often “stop accepting particular health plans’ members off and on throughout the year and fail to notify the plan in a timely manner” (Pear, New York Times, 5/8).
