Isn’t it interesting that issues that have been around for years, even decades and which cannot be effectively solved suddenly have the attention of government that then comes up with quick solutions via regulations?
The fact is provider directories are never 100% up to date given the constant changes being made. Soooo… what would a reasonable person do? What I told employees was very simple. Before you enroll in a plan, first check the directory to see if your doctors participate, then call your doctor’s office to verify they participate. When annual enrollment comes around, again call your doctor to be sure he intends to remain in the plan. Simple uh? Just common sense acting in your own best interest.
As far as the out-of-cost calculator goes; not exactly a new idea. In fact, the new summary of benefits which is required of all plans contains several mandatory examples to illustrate OOP costs. But the biggest drawback is trying to estimate ones actual costs. Do you know what you will spend, what your health care needs will be in the next twelve months? If you have regular care because of a chronic or ongoing health problem, your Explanation of Benefits for the previous year will tell you what you spent and what was reimbursed. In most cases patients can get this information on-line.
As always, these ideas, tools and efforts all depend on one thing …. getting people to pay attention and use them. Good luck with that!
WASHINGTON — The White House is moving to address two of the most common consumer complaints about the sale of health insurance under the Affordable Care Act: that doctor directories are inaccurate, and that patients are hit with unexpected bills for costs not covered by insurance.
Federal health officials said this week that they would require insurers to update and correct “provider directories” at least once a month, with financial penalties for insurers that failed to do so. In addition, they hope to provide an “out-of-pocket cost calculator” to estimate the total annual cost under a given health insurance plan. The calculator would take account of premiums, subsidies, co-payments, deductibles and other out-of-pocket costs, as well as a person’s age and medical needs.
Since insurers began selling coverage through public marketplaces 19 months ago, many consumers and doctors have complained that the physician directories are full of inaccuracies. “These directories are almost out of date as soon as they are printed,” said Kevin J. Counihan, the chief executive of the federal insurance marketplace.
Medicare and Medicaid officials have found similar problems in the directories of insurance companies that manage care for beneficiaries of those programs. In December, federal investigators said that more than a third of doctors listed as participating in Medicaid plans could not be found at the locations listed.
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