If you think you’ll be able to see the doctors and use the hospitals you want in a Medicare Advantage plan, think again. Medicare Advantage plan provider directories tend to be misleading, at best. Providers leave networks throughout the year, and it’s on you to speak with your treating physicians to confirm that they are in-network and have no plans to leave.
In recent news, Alan Goforth reports for BenefitsPRO that Cigna just settled a class action lawsuit for having provider directories that included physicians and hospitals that did not exist or could not be reached. Cigna is paying the plaintiffs $5.7 million to settle.
It appears to be common for insurers to have what are called “ghost networks.” These are networks that look good on paper, filled with names of physicians and other health care providers. But, when you start investigating, you find that many of the names in provider directories are not the names of providers that are taking new patients or otherwise available to see in-network.
Cigna is not the only insurer with ghost networks. There are allegations against UnitedHealth, Elevance Health, Anthem Blue Cross and Carelon Behavioral Health for having ghost networks. These networks can end up costing enrollees thousands of dollars.
In some cases, people use hospitals they believe to be in network and only learn afterwards that the hospital was out of network. But, in general, insurers do not face penalties for having misleading provider directories. The Medicare Advantage directories have been found to be largely inaccurate for years, but the government has done nothing to ensure their accuracy.
Here’s more from Just Care:
- Insurer provider directories misleadingly include physicians who are out of network
- Medicare Advantage delivers unreliable coverage
- Medicare Advantage networks can be narrow and harmful
- Ten ways Medicare Advantage plans differ from traditional Medicare
- Medicare Advantage needs an overhaul
