Arthritis Foundation Legislative Position Statements

Arthritis Foundation Position Statement on Accurate Provider Network Directories

Issue

People with arthritis have very specialized care needs and select insurance plans based on access to doctors who are specialists in practice areas such as rheumatology. Frequently, the selection comes about because of information contained in directories provided by insurers. These directories tell a prospective member if doctors and facilities are in the network, where they are located, their specializations, experience, whether they accept new patients, age restrictions on new patients and other important information about access.

Background

Many insurance directories are not frequently updated or are outright inaccurate. These inaccurate provider directories can mislead a person about coverage and cause a patient to pick a health insurance plan that is not the most beneficial, nor is in the best interests of the person or their family and doesn't meet their needs.

Arthritis Foundation Position

The Arthritis Foundation supports legislation that provides accurate and reliable information about insurance benefits to current and prospective enrollees and provides the following:

  • Directories that are current and accurate.
  • Printed directories that are updated every three months to include the most current information at the time of printing; electronic directories that are updated within three days of an insurer learning of a change to directory information; and proactive measures by insurers to ensure the accuracy of directory information.
  • Notification by insurers to enrollees when a significant change occurs to coverage. Changes such as a doctor of the insured leaving the network or leaving the profession should be conveyed in writing to the insured within 10 business days of the change.
  • When a provider directory is inaccurate, require that insurers provide coverage to an enrollee at a cost that is no greater than if the benefit were obtained from a participating provider.

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