Knowing your doctor or hospital or pharmacy is in the network is a big part of making a good decision about which Medicare plan to select. Over the past year there have been an increasing number of consumer complaints about network changes in Medicare plan and outdated information in plan directories.
The Centers for Medicare and Medicaid (CMS) said it is going to be watching Medicare Advantage plan network directories and will penalize plans that don’t have accurate in-network physician information.
CMS said Medicare beneficiaries have complained of directories in which providers no longer contract with an Advantage plan, or directories still include in-network doctors who have retired or moved locations. Some online provider lists do not indicate if doctors refuse to take new patients.
Because of the problems, CMS said it wants insurers to update provider data, such as contact information and whether doctors are accepting new patients, at least four times per year. Insurers will also have to correct mistakes in the online directories and develop a process to handle cases when members are denied access to an in-network provider
“Having listened closely to hundreds of thousands of consumers about what matters most to them in choosing a Medicare plan, we at iQuote by Longevity Alliance understand that “how and where they get their care” usually ranks below only a plan’s total expected cost,” said Darren Gruendel, President, iQuote by Longevity Alliance. “So we applaud efforts to make directory information more accurate and transparent.”
CMS is proposing by 2017 to have all network data in a standardized electronic format.
“When physician or pharmacy information is incorrect, what appears to be an ideal recommendation can fail to meet even the most basic coverage needs and that can be catastrophic for an individual on a fixed income. Helping people understand what makes smart plan choices is not hard, if we just listen objectively, but getting them into plans that actually work requires accurate data all around,” Gruendel added.