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Lawmakers press plans on directories, 'ghost networks' and the need for apples-to-apples data
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Summary
Members urged CMS and insurers to fix inaccurate provider directories and publish comparable data so beneficiaries can make informed choices; proposals included allowing plan-finder searches for a patient's current doctors and requiring annual directory updates.
Lawmakers and witnesses told the House Ways and Means joint subcommittee hearing that inaccurate provider directories — so-called “ghost networks” — and limited public data hamper beneficiaries’ ability to choose plans and can result in unexpected out-of-network bills.
Brookings senior fellow Matthew Fiedler and Rep. Michael Burgess (questions) and Rep. Tom Bean (remarks) referenced personal and constituent experiences illustrating the problem. Dr. Brian Miller, a physician and witness, said he personally “incurred an $8,000 out-of-network medical bill because the provider directory was not up to date,” and recommended that the Medicare Plan Finder include a function, similar to the ACA marketplace, that lets beneficiaries check whether a given doctor or hospital is in a prospective plan’s network.
Rep. Michael Burgess (chair/commenter) and others said a legislative fix to require more accurate, frequently updated directories would protect beneficiaries. Representative Danny Davis and others urged an “apples-to-apples” comparison of MA and traditional Medicare costs and outcomes; Rep. Bean said he filed an “apples to apples” bill directing CMS to release fuller comparative data.
What witnesses suggested: Plan-level publication of provider-directory accuracy measures, searchable plan-finder tools that accept a beneficiary’s current provider names and return network status, and annual director-update requirements enforced by CMS. Brian Miller said making directories usable at point of sale would reduce surprise out-of-network encounters and enable oversight audits.
Committee follow-up: Members from both parties asked staff to examine the Real Health Providers Act (a bill introduced by members of the committee that would require annual provider-directory updates) and the Bean “apples-to-apples” data-release proposal. The hearing did not include a vote on either measure.
