Faulty Doctor Lists
As insurers continue to narrow network doctors out of business it has come to light that their information is inaccurate:
- California’s biggest health insurers reported inaccurate information to the state on which doctors are in their networks, offering conflicting lists that differed by several thousand physicians, according to a new state report.
- …insurers may be misrepresenting which providers they have under contract or are unable to collect accurate information.
- UnitedHealthcare, the nation’s largest health insurer, listed 9,135 primary-care doctors on the provider list used during the year who were absent from year-end list — a discrepancy of 45 percent.
- Cigna, another big insurer, named 8,572 on the one list who were not on the other, a 36 percent discrepancy. For Anthem Blue Cross, the discrepancy was 8,165 primary-care physicians, or 36 percent, and for Blue Shield of California it was 4,371 primary-care doctors, or 22 percent.
- In another instance, the state said Aetna counted the same cardiologists in one county more than 160 times, inflating the number of specialists overall by 2,293. That overstated the list of specialists by 82 percent.
- Overall, for seven insurers, the two sets of lists differed by 50 percent or more for in-network specialists.
Patients are getting screwed. Doctors are getting screwed. And the insurers couldn’t give a damn.
One my favorite questions. “I have to change insurance. Doctor are you in this insurance program? ” My answer. I don’t know. I was in a big multi-specialty group. What insurance programs we were part of seem to change monthly.
This is a pet peeve of mine. The Blue Cross Obamacare division routinely sends me lists of “my” patients, none of whom I have ever seen/heard of. These lists have no return contact information (such as a name or phone number to call & correct). Just a corprate headquarters address in Dallas. My practice is largely full and closed to all but new OB patients. A sixty year old lady showed up this week with HTN, DM and high cholesterol with an abnormal mammogram ordered by the nurse practitioner in another clinic – the Blue Cross will no longer pay for. Tag – your it. It is a scam on the public to show that they are “providing” health care and a scam on the doctors by taking away our say-so in who we accept into our practice. In essence, we work for the insurance company.
We have been dealing with this in Maryland for a number of years. We have passed laws to direct our Insurance Commissioner to ascertain the adequacy of the networks, to be sure the docs are indeed on the panel, are alive, are still practicing, and actually do the kind of work they are being advertised as doing (ie, pediatric orthopaedists being billed as adult, etc)
We have had some success with this, but we, too, feel the pain.