It turns out that two of the most common consumer complaints about HIX plans mirror longstanding gripes about traditional health insurance, but theres a movement afoot to ensure provider network directories are accurate and help patients better calculate and budget for out-of-pocket costs in the nascent online marketplace.
Insurance carriers whose health plans are sold in federal or state-run public exchanges would be required to update or correct their directories at least monthly or face fines of up to $100 a day for each violation, while a link to an out-of-pocket cost calculator would enable health plan members to more accurately determine their annual premiums, subsidies, copayments and deductibles when making online comparisons of health plans. Those estimates also would take into account an individuals age and medical needs.
These directories are almost out of date as soon as they are printed, HIX czar Kevin Counihan recently told The New York Times.
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Under these stricter standards, each HIX plan reportedly must include accurate provider contact information, as well as the office location, area of specialty, medical group, any institutional affiliations and whether theyre accepting new patients. The information also is expected in a format that will make it easier for enrollees to match their doctors with health plans.
Inaccurate provider directories could be seen as a violation of federal standards for network adequacy. They also could spike costs for consumers who end up seeking treatment outside a health plans provider network and undermine doctor referrals to specialists.
Americas Health Insurance Plans indicated in a recent letter that one frequent complication its members have faced is when physicians stop accepting particular health plans members off and on throughout the year and fail to notify the plan in a timely manner.
