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Member complaints lead to ACA Changes

Good News for people who bought health plans on the exchange or more commonly referred as “The Affordable Healthcare Act” aka “ObamaCare”. The government is adding more guidelines for provider directories for health insurance companies. The changes are directly related to the volume of complaints from you, the member. Why is this good?

The provider directory is your primary source for finding doctors, hospitals, specialists, etc., who participate with your health insurance. The provider directory contains the doctor’s or facility’s hours of operation, location information, specialty, and provider affiliations to name a few. If this information is inaccurate, this may result in misdirected referrals to out-of-network providers or to providers who do not accept new patients. Doctors use the provider directory to refer you to other specialists and facilities for care. Mistakes can often lead to you, the member, paying more for healthcare than necessary.

Health insurance plans will now be penalized for inaccurate provider directories, possibly a $100 a day per impacted member (you). This is a step in the right direction; however, there is a twist!

While insurance companies load the data for the provider directories, the information comes directly from the providers. There are several sources of error, which are not all directly related to health insurance companies. Providers are still not held accountable for providing mistakes in data to health insurance companies. This will likely continue and should also be addressed…. All in time, this is just a start to the Affordable Healthcare Act changes to come.

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