Less Than Half of Doctors in Insurance Directories May be Available

(Reuters Health) - More than half the dermatologists in Medicare Advantage plan directories were either dead, retired, not accepting new patients or specialized only in specific conditions, researchers found when they tried making appointments.

Inaccurate directories of doctors covered by an insurance plan may lead to people having very few options and to the U.S. government approving plans that don’t meet standards regarding provider availability, the study team writes in JAMA Dermatology.

“I think it just identifies a big area that needs a lot of help to increase transparency to patients,” said Dr. Jack Resneck, Jr. from the University of California, San Francisco, the study’s lead author.

The U.S. requires private insurance plans offered through Medicare (the government-run insurance program for the elderly and disabled) and through exchanges set up by the Affordable Care Act to offer plan participants a variety of doctors.

Even so, insurers have been increasingly "narrowing" their networks by eliminating contracts with physicians, the researchers write.

They add that there is increasing attention toward the limited choices offered to patients through the private plans in Medicare - known as Medicare Advantage - and the Affordable Care Act.

For the new study, Resneck and his colleagues analyzed the accuracy of the lists of dermatologists that insurance companies said accepted Medicare Advantage plans.

The directories, from 12 U.S. metropolitan areas, included the names of 4,754 dermatologists. About 46 percent of those doctors were listed twice, however.

The researchers then attempted to make appointments with dermatologists, for a fictional father who had an itch for months and was about to select a Medicare Advantage plan.

Of the remaining 2,590 dermatologists listed in the directories, about 18 percent were not reachable, about 9 percent had retired, died or moved and another 9 percent were not accepting new patients.

Overall, only 1,266 dermatologists – or less than half – were reachable, accepted the specific Medicare Advantage plan and offered an appointment.

For one of the plans, the researchers were not able to make an appointment with any of the listed dermatologists.

What’s more, the average time the fictitious patients had to wait for an appointment was about 46 days.

Resneck said different plans in different geographic areas varied in the accuracy of their directories.

“Across the board, nobody scored that well here,” he said. “I thought because of the attention that had been paid to this, I thought insurers would have paid some attention to cleaning up these directories.”

The researchers note that they can’t tell whether the inaccurate directories are misleading federal regulators, because they weren’t able to access the reports that health plans submit to the government.

They also don't know if the results would be similar for other medical specialties.

“We can’t say for sure, but I see no reason why insurance companies would have a particularly difficult time keeping their dermatology directories up to date,” Resneck said.

Earlier this month, a study found many errors in insurance directories of psychiatrists (see Reuters Health story of October 17, 2014 here: reut.rs/1039tdK).

"Medicare Advantage plans do provide a wide range of providers and specialists to meet beneficiaries’ diverse health needs," said Clare Krusing, director of communications for America's Health Insurance Plans, which is the national trade association representing the insurance industry.

"There is a shared responsibility between providers and health plans to ensure seniors have access to the care and resources they need when it comes to their health care choices," Krusing added in her email to Reuters Health. "Greater transparency on the part of those specialists participating in provider networks is critical to making this happen."

Resneck said insurance companies should “hit the pause button” before removing any more providers from their insurance plans.

“Taking more and more physicians out of an insurance network when there is already a long wait can only make that worse,” he said.

SOURCE: bit.ly/10z87bK JAMA Dermatology, online October 29, 2014.

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