Consumer Experiences with Provider Directories and Support for Federal Action

• In Event: Navigating Healthcare Services and Resources

Abstract

The majority of insured Americans enroll in insurance plans that use a defined network of providers. In-network physicians and other medical providers are those who have contracted with an insurer to provide services to the insurer's enrollees (patients). Consumers learn about the networks of insurers through provider directories. Provider directories play a crucial role in how consumer experience health insurance and medical care. For one, consumers rely on the directories to make plan selections during open enrollment. Even more importantly, consumers use the directories to seek out providers when they need medical care. Thus, provider directories play an outsized role in whether and how consumers access needed health care in a timely fashion.
An emerging literature using government auditing data has shown that provider directories are often inaccurate, and often substantially so. The accuracy in provider directories is a seemingly technical detail, yet a flawed directory can substantially increase consumers’ administrative burdens locating health providers and it may affect how and whether they access needed care. Ultimately, flawed provider directories may thus affect both the health and financial well-being of consumers. However, while a growing literature has used administrative data to highlight the extent of inaccuracies, scholarship on the effect on consumers and their lives has been severely limited.
To fill this gap in the literature, we conducted a large innovative survey of more than 8,000 Americans via Lucid from January to April 2022 that queries respondents about their experience navigating provider networks as well as their attitudes on potential policies to protect consumers.
Specifically, after providing a brief description about the role of provider directories to respondents, we asked whether respondents used a provider directory given by the insurance to search for doctors or other medical providers. Among those who indicated yes, we engaged respondents further with a series of questions about ease of using the provider directory, such as problems encountered when trying to contact listed providers (e.g. providers “Could not be reached because of wrong contact information”, “not accepting your insurance”, “providers never worked in this practice”). Respondents were further probed about consequences of these problems including delaying treatment or seeking care at an emergency department. We also inquired about severity of health and financial consequences as a result of provider directory accuracy problems.
From a policy perspective, the question emerges whether experiences with provider directories affect support for policy actions. To answer this question, we also queried respondents about support for various policy solutions to the issue of provider directory inaccuracies at that being discussed at the federal level. Proposed policies ranged from requiring insurers to update directories regularly to imposing fines or allowing patients to sue insurers over inaccuracies.

Authors

• Wendy Xu, The Ohio State University

• Simon F. Haeder, Texas A&M University