Assessing Access to Neurologists Using a Secret Shopper Survey in California and Pennsylvania

Adequate provider networks and accurate provider directories are crucial to ensure access to medical care in managed care. Existing research suggests substantial barriers. These barriers have not been assessed for neurologic care and only in a limited way for the Affordable Care Act market. We sought to assess access to neurologic care in California and Pennsylvania.

We conducted a simulated patient survey in which trained callers posed as patients seeking care on behalf of 1,085 simulated patients (4,328 calls) from May to November 2022 during initial implementation of the No Surprises Act directory accuracy provisions. When an appointment was successfully scheduled, callers recorded the appointment date. We also calculated the driving time. For unsuccessful contact attempts, callers recorded provider directory inaccuracies, provider capacity limitations, staff refusal to provide information, or failure to reach anyone capable of verifying information.

Only 2,316 of 4,328 calls (53.5%) reached a person capable of verifying provider information. Considering all 4,328 call attempts, including those that could not be verified, 15.7% resulted in a successfully scheduled appointment. Among verified calls, 29.3% successfully secured a nonemergency appointment, with substantial variation by state (California 37.4% vs Pennsylvania 21.6%), plan type (HMO 34.6% vs EPO 17.7%), insurer tax status (not-for-profit 41.7% vs for-profit 17.6%), and market presence (multistate 37.4% vs single state 18.5%). The mean wait time to appointment was 70.9 days overall and 103.4 days in Pennsylvania. The mean driving time was 32.9 minutes and nearly doubled for rural patients (55.3 vs 27.8 minutes). Provider directory inaccuracies were encountered in 58.2% of verified calls, most commonly incorrect contact information (35.3%), with higher rates in Pennsylvania than California (68.5% vs 49.3%) and for EPOs than HMOs (71.9% vs 51.3%). An additional 7.8% of calls encountered provider capacity limitations.

Practicing neurologists bear downstream costs from directory errors through misdirected calls. Referring clinicians should be aware that marketplace enrollees may face substantial delays in accessing neurology care. Current regulatory regimes may not fully protect patients. Differences across states as well as plan and insurer type suggest systematic variation in access. Rural patients face particular obstacles.