Persistence of provider directory inaccuracies after the No Surprises Act

Provider directory inaccuracies have important implications for care navigation and access as well as ongoing regulatory efforts. We assessed the extent to which identified provider directory inaccuracies persisted across 7 specialties (cardiology, dermatology, endocrinology, gastroenterology, neurology, obstetrics-gynecology, primary care) and 5 carriers in the Pennsylvania Affordable Care Act insurance marketplace.

A secret shopper survey recontacted inaccurately listed providers (N = 1802) between 403 and 574 days after they were identified in an earlier secret shopper survey.

Descriptive analyses, with tests of proportion and t tests to assess whether differences across carriers, specialties, and geographic locations were statistically significant.

Of 1802 inaccurate provider listings, 451 (25.0%) had been removed at follow-up, 966 providers (53.6%) were successfully contacted, and 385 providers (21.4%) could not be reached. Of the recontacted providers, 240 (13.3%) were listed accurately at follow-up and 726 (40.3%) were listed with various inaccuracies, including 31.0% (n = 558) with inaccurate contact information, 11.2% (n = 201) listed under the wrong specialty, and 1.9% (n = 34) erroneously listed as being in network despite being out of network. We found substantial differences across carriers and specialties but not by rurality. Inaccuracies also were less likely to persist in the state's 2 metropolitan areas. Among inaccurate provider listings, on average, 540 days (median, 544 days) had passed between the initial and subsequent contacts.

A large number of provider directory inaccuracies persist well beyond the 90-day expectation mandated by federal regulations, raising substantial concerns about compliance. These inaccuracies may impose substantial barriers to patient access and may render existing assessments of network adequacy ineffective.