Not too long ago, the provider directories published by health plans looked like phone books and contained scant information. Today, these resources are largely online (though print versions are still available) and can – if managed wisely – be invaluable sources of information for consumers.

But the “if” here is a big one; too often, payors and providers alike find themselves challenged to keep up with the data demands, and reliability suffers. Earlier this year, Atlas Systems revealed that almost 4 in 10 provider directory listings contain at least one error.

One widely publicized outgrowth of this flawed data has been a surfeit of surprisingly high medical bills, generated when patients visited doctors and others who were mistakenly reported to be “in-network” for their plans. In the Federal government’s 2022 No Surprises Act, provider directories were singled out as a likely cause of many unexpected bills, and the legislation mandated quarterly refreshes of provider data.

Defining the Unseen Costs

But surprise bills are just one of the costs – many hidden or rarely discussed – associated with outdated and inaccurate provider directories. Recently, an Atlas Systems study among 1,000 US consumers showed that many in the US have indeed encountered flawed directory information – and that it has taken a toll on their relationships with their health plans.

The Atlas Member Experience Monitor survey shows that 62% of US consumers who have health insurance now or had it in the past have used online directories to search for providers. Of these, more than half (55%) found inaccurate information about practitioners in the directories they searched. That translates to roughly one-third of all US consumers – or about 100 million people.

Who Is to Blame?

Knowing how prevalent the experience of inaccurate data had become, Atlas wanted to understand who was taking the rap for these shortcomings. In the Member Experience Monitor research, consumers were split over who was primarily responsible for accurate directory data. The majority (58%) said that insurance plans bore most of the blame for problems with online directories.

But a surprising one in three (34%) said that health providers were primarily at fault for flawed directory listings – showing that doctors and others cannot consider themselves invisible in this troubled situation.

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Most Likely to Mislead

Atlas Systems also asked health plan members which specific pieces of directory information had proven to be wrong – and the clear “winner” was a crucial data point: Whether a doctor or practice is accepting new patients, which was found to be inaccurate fully 50% of the time.

Other sources of incorrect information include:

  • 28% calling or emailing the wrong practitioner
  • 26% discovered that the provider had retired or passed away
  • 25% learned the health professional’s specialties were not as described
  • 24% received an unexpectedly high medical bill

A Brand Crisis for Payors

For payors, provider directories should be a very visible brand asset – a sign of the value health plans deliver to their members. However, our study revealed a striking and disturbing consequence of today’s prevalent directory errors. Among plan members who found mistakes in online health directories, a stunning 82% said the experience made them less likely to trust the health plan involved.

This shows that, for four-fifths of those who found errors, there was a direct effect on brand loyalty. At a time when health plan choice is often a matter of one or two clicks based on scant experience, this kind of negative feeling can hit payors’ bottom lines in a big way.

The Verdict Is In

For payors and providers alike, the Member Experience Monitor study has clear messages. The effects of unreliable provider data extend way beyond surprise medical bills; they go to the heart of the relationships between payors and members, and between practitioners and patients. The member experience is indeed a mantra for payors today – but many don’t seem to understand how that experience can be undermined by bad memories and distrust. It is essential to rebuild a bridge to members and patients by meeting their needs; give them the reliable data they need, delivered in an intuitive environment, and your brand will be safe.

About Atlas PRIME

PRIME is a service of Atlas Systems that offers a rigorous, proven approach to provider data validation and management. The PRIME goal is to help insurance plans deliver great member experiences – and stay in compliance with mandates like the No Surprises Act.

Atlas PRIME has achieved best-in-class status with a provider data accuracy rating of 95% through client-audited quality assurance and up to 90% validation success. Other services often rely on aggregated data, using sources of unknown reliability. PRIME takes a different approach. They deliver data validation from the source, reaching out directly to contracted health systems, provider groups, and individual practices.

John K. Lamb worked for over 40 years within major health insurance companies, taking on key claims, provider, and compliance issues. He is now Vice President of Provider Operations at Atlas Systems, working on our PRIME service.

Learn more about our provider data management services and request a free consultation

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