AB 236 (Holden), which seeks to improve the accuracy of health plan provider directories for consumers, now heads to the California Senate.
***Impacted consumer stories available upon request***
SACRAMENTO, CA – Today, the California State Assembly passed AB 236 by Assemblymember Chris Holden, which will ensure accurate health plan provider directories, and help consumers who are trying to pick a provider or a plan. To address the frustration of patients searching through often outdated and inaccurate “ghost” listings, this bill requires that health plans annually verify the information in their provider directories per standards set by health regulators, and sets accuracy benchmarks to enforce existing law, SB 137 (Hernandez 2015). These annually increasing accuracy benchmarks will require that health plan provider directories be 95 percent accurate by 2028. These requirements seek to improve and maintain provider directory accuracy for consumers, so that they can find the care and coverage they need.
While every health plan in California is required to maintain an updated list of in-network health care providers for their enrollees, these directories often list providers such as doctors, mental health professionals, hospitals, labs, imaging centers, and more that are not in the health plan’s network, or not accepting new patients. When the providers on these lists are unreachable or do not actually provide care to consumers covered by that health plan, consumers too often have their care denied or delayed. They may even feel forced to seek necessary care out-of-network and pay inflated rates. These inaccuracies have the greatest impact on consumers who already face the worst access, such as those with limited English proficiency, persons with disabilities, and others in marginalized communities thus worsening inequities in health care.
Existing law, SB 137 (Hernandez 2015), requires the inclusion of basic contact information for providers listed, regular updates by health plans and an annual review by the regulating department. It also mandates that if a consumer visits a provider listed as in-network by their plan’s directory, but the provider turns out to be out-of-network, then their plan must pay as if the care were in-network. However, this law has not effectively ensured the accuracy of these directories.
In fact, one health plan was found to have an error rate of 80% for non-physician mental health professionals with most having error rates of 20%-30%. Error rates vary among health plan directories but are highest for non-physician mental health professionals and psychiatrists; error rates are also high for primary care and specialty care providers.
“Provider directories are meant to help consumers find care and shop for a health plan, but many consumers have had care delayed because they have to sift through listings that are grossly inaccurate,” said Katie Van Deynze, policy and legislative advocate with Health Access California, the sponsor of the bill. “AB 236 puts benchmarks and policies in place to get our state to accurate health plan provider directories, so that Californians can access the services that they need. This is a critical bill to breaking down barriers to care, and we applaud the Assembly for passing this bill to the Senate.”
“When we shop at the supermarket, we see the correct ingredients are listed on the label, but Californians sadly can’t have that same confidence when comparing the often-inaccurate provider directories of health plans.” said Anthony Wright, executive director of Health Access California. “This bill puts health plans on a path of improvement, so patients no longer have to call through ghost networks of outdated listings of providers that have moved, retired, or are not accepting new patients.“
Health Access has collected numerous stories of patients frustrated with ghost networks and inaccurate provider directories, many of whom are willing to talk to media. As Susan F, of Santa Ana, said, “When you tell a Blue Shield representative about [inaccurate provider listings], they say, ‘well, call us back with the list that you have of doctors that are not calling you back or not taking new clients or are no longer in the network and let us know.’ Why do we, [the consumers] have to do the leg work?”
The bill’s author, Assemblymember Chris Holden stated, “Ghost networks should not be something we accept as reality, and AB 236 ensures that every Californian will have access to the care they need by assuring the information given to them remains accurate and accessible. I appreciate the support of Health Access and look forward to working on the bill in the Senate.”
By establishing mechanisms of accountability and streamlining the process, AB 236 will improve the accuracy of health plan provider directories across the state, ensuring that consumers can rely on directories to find the care they need.
Press inquiries can be directed to:
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