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In-network providers: now you see them, now you don’t

A June 28 Becker’s Hospital Review article tells a “ghost story” about providers mysteriously vanishing from health insurer network directories.

“Come join our health plan—look at this huge list of in-network providers! Scroll through the directory and check out the breadth of our coverage! Just sign here.”

Sounds like a good deal, doesn’t it? Until you need a doctor and, whoops! A huge chunk of the names in that directory aren’t actually available to you. Why? Because they’re not in your network.

As Becker’s tells it, that’s the basis of the June 25 suit filed by San Diego City Attorney Mara Elliott against three health insurers: Kaiser Permanente, Molina Healthcare, and HealthNet. Elliott claims that Kaiser’s provider directories, as well as those of HealthNet, a subsidiary of Centene, have error rates—a provider listed as being in network when they’re actually not—of at least 35%. And Molina’s? They’re up to 80% erroneous, according to Elliott.

The issue here, as Elliott puts it in a press release, is that the “false, out-of-date, or incomplete information found in these ‘ghost networks’ impede attempts by enrollees to find needed care from in-network providers.” In other words, when you check your health insurance company’s directory of in-network providers to look for the care you need, you’re going to find between 35-80% of the names are actually not in your network. An even worse scenario is that you go to see a listed provider and later find out they’re not covered. Guess who gets that bill, we want to know.

If this is a bait-and-switch situation, and not an unpaid intern managing the database, it’s a particularly underhanded move. How many people buy insurance based on in-network providers and only discover the truth after they’ve enrolled? We’ll have to wait to find out what the insurers’ defense will be, because they were unable to comment at the time the Becker’s article was published. But we’re sure it will be a good one.

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