Error-filled directories leaves thousands in Pa. unable to find health care providers

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HARRISBURG — The information that thousands of Pennsylvanians rely on to find health care providers and schedule appointments is riddled with inaccuracies that often go months without being corrected, in violation of federal requirements, according to a study commissioned by the state Insurance Department.

Insurance companies are required by law to publish up-to-date lists of health care providers in their networks. But the study, based on surveys of more than 7,700 providers across all eight companies that sell insurance plans through the state’s Affordable Care Act marketplace, found widespread inaccuracies in those listings.

A record 490,000 Pennsylvanians bought insurance coverage through the state’s ACA marketplace, Pennie, during the open enrollment period for 2025, according to the Insurance Department.

Flawed directory information often went unaddressed for months, the study found — despite a federal law that requires insurance companies to update provider listings every 90 days at minimum. The law also requires insurers to purge from their directories providers whose information they cannot verify. The state Insurance Department is responsible for enforcing the law in Pennsylvania.

Consumers rely on these directories to choose insurance plans, book appointments, and avoid higher medical bills by finding providers who are in-network. When that information is inaccurate, patients are more likely to delay or forego care altogether, said Simon Haeder, an associate professor at Texas A&M University and the study’s author.

Incorrect directory information “sounds like a technical issue,” but “it’s really, really important,” Haeder said. “Just because you have an insurance card doesn’t mean you can access care.”

A spokesperson for the Insurance Department said officials are concerned by the study’s findings and “will address, according to its jurisdiction, all inaccuracies found in the report.” The department commissioned the report to understand how insurance companies were adapting to the requirements of the federal No Surprises Act, the spokesperson said, and having specific data will allow it to develop “targeted solutions.”

The study, conducted over the course of 2022 and 2023, involved a series of “secret shopper” surveys of thousands of provider listings — more than 28,100 phone calls in total.

When the initial survey found issues, callers followed up several months later to determine whether the errors had been corrected. In many cases, they had not: Both follow-up surveys found that more than 40% of provider listings initially identified as erroneous still included at least one piece of wrong information.

The most common error was inaccurate contact details, followed by incorrect information about a doctor’s medical specialty; info about whether a provider was in network was less likely to be wrong.

Some level of inaccuracy in provider listings is inevitable because the industry is dynamic: doctors move offices, merge their practices, and change their phone numbers and the insurance they’ll accept. But the persistent errors raise questions about whether insurers are complying with a federal law intended to address the problem, the study argued.

The No Surprises Act, which took effect in 2022, aims to protect consumers nationwide from unexpected out-of-network bills. The federal law requires insurance companies to update their provider directories at least every 90 days. But the surveys found that inaccurate information was often left uncorrected after an average of 190 — or even 540 — days, raising “substantial concerns” about whether companies are following the law.

“The data adds another layer of concern to the already existing concern of widespread inaccuracy,” Haeder said. “These are not just temporary issues when, for instance, someone moves and it takes a little bit of time to get it addressed.”

The study also found that insurance companies removed bad info at significantly different rates. One follow-up survey found that Ambetter removed 35% of inaccurate listings, while Independence Blue Cross removed 9%.

Some of the variations can be explained by differences in geography, Haeder said — insurers that mostly enroll customers in urban areas where there are more doctors likely see more provider turnover, which increases the likelihood of inaccuracies. But the variation also indicates companies take different approaches to verifying and updating directory information, and that some commit more resources to the task than others, the study concluded.

To address the problem, the study recommends several policy changes. The state Insurance Department could require insurers to share the steps they take to update provider information. Providers whose details can’t be properly verified could be kept out of directories. The department could also crack down on insurers and providers that don’t comply with the law by issuing steeper fines and penalties, the study suggests.

An Insurance Department spokesperson said the agency is working with insurers, providers, and other stakeholders to discuss the recommendations and identify solutions.

Asked about the study’s findings, insurers told Spotlight PA that maintaining accurate directories is an industry-wide challenge that involves working closely with doctor’s offices and hospitals. Some also said they are committed to working with the Insurance Department to address the report’s findings.

Inaccurate provider directories are a longstanding problem, well-documented in years of studies by state and federal regulators and independent researchers.

“This was not a surprising finding,” said Patrick Keenan, director of policy and partnerships at the Pennsylvania Health Access Network, which advocates for affordable health care.

“It’s part of a pervasive and persistent pattern when patients don’t have access to enough doctors, or doctors that they think they have access to – they actually don’t.”

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