Washington, D.C. — U.S. Senators Michael Bennet (D-Colo.), Thom Tillis (R-N.C.), Ron Wyden (D-Ore.) introduced the Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act to ensure Medicare Advantage plans maintain accurate provider directories and protect seniors from unexpected health care costs.
“We are experiencing a massive mental health crisis across America – but instead of getting the care they need, Coloradans tell me they’re struggling to find timely care,” said Bennet. “Congress urgently needs to act to improve access to mental, behavioral, and physical health care across the country. Our bipartisan bill would make it easier for Colorado seniors to find and see providers covered by their health plan.”
“Far too often, North Carolinians, especially seniors enrolled in Medicare Advantage and those in need of mental health services, find themselves unable to access the care they need due to inaccurate provider directories,” said Tillis. “This legislation ensures that consumers can access updated provider information enabling them to make informed decisions about their healthcare.”
“When Americans are purchasing and using their health insurance, they have the right to know whether their doctors are covered by that plan,” said Wyden. “Too often, seniors and families get health care whiplash when they sign up for a plan only to find out that their preferred doctor is out-of-network, or it’s impossible to find a covered mental health care provider. This bipartisan legislation is a big step towards holding insurance companies accountable so their provider directories are accurate, and I’ll be working hard to get it passed.”
Many seniors enrolled in Medicare Advantage rely on their health plan’s provider directory to find in-network physicians and practitioners, but inaccurate data can make it harder to find a provider or lead to unexpected costs. These inaccurate provider directories are known as “ghost networks” because some listed health care providers are not in a patient’s network, are not accepting new patients, or in some cases, are no longer in business. Ghost networks make it more difficult for patients to find in-network health care providers, a more acute issue in the mental and behavioral health fields, resulting in unexpected costs or delayed care for patients.
Specifically, the REAL Health Providers Act would:
- Strengthen requirements for Medicare Advantage plans to maintain accurate and updated provider directories;
- Ensure patients do not pay out-of-network costs for appointments with providers that were incorrectly listed in their plan’s provider directory as in-network; and
- Direct Centers for Medicare and Medicaid to publish guidance for plans to maintain accurate provider directories.
“In the midst of a mental health and substance use crisis, people need to easily and quickly access the help they need. The federal government pays Medicare Advantage plans to provide timely services, but their inaccurate provider directories lead to frustration, financial hardship, delay, and denial of care,” said Mary Giliberti, Chief Public Policy Officer, Mental Health America (MHA). “MHA supports this bill as an important step forward in addressing this persistent problem that causes so much harm to people with mental health and substance use conditions and their families.”
“Inaccurate provider directories may sound innocuous, but they prevent people from getting treatment or stick them with surprise bills for out-of-network care. Inseparable applauds Senators Bennet (D-CO) and Tillis (R-NC) for their bipartisan collaboration on this bill that will help protect people from those unfair charges,” said Bill Smith, Founder and President, Inseparable.
The text of the bill is available HERE. A summary of the bill is available HERE.