Labor Dept. Warns Health Plans Over Inaccurate Provider Directories
A federal survey found 36% of provider directory listings were wrong, leaving workers exposed to surprise out-of-network costs.
The U.S. Department of Labor on Wednesday issued an enforcement alert directing employers and health plan fiduciaries to ensure their provider directories are accurate and regularly updated, citing widespread errors that can trap patients with unexpected medical bills.
An undercover survey by the department's Employee Benefits Security Administration, in which investigators contacted more than 27,000 providers across 27 networks, found that more than one-third of directory listings contained incorrect information. The errors ranged from listing physicians who are no longer in-network to outdated contact details, creating barriers that can delay or entirely deter patients from seeking care.
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The compliance concerns run deeper than simple data hygiene. Using a "pathway to service" metric — which measured whether a listed provider could be reached, confirmed as in-network, and seen by a new patient within 30 days — EBSA determined that 66% of medical and surgical providers fell short. Among mental health and substance use disorder providers, the failure rate climbed to 74%, a gap that advocates say carries serious consequences given ongoing demand for behavioral health services.
Health plans and insurers are legally obligated under the Employee Retirement Income Security Act and the No Surprises Act to maintain current directory data. The enforcement alert spells out fiduciary responsibilities under those statutes and offers a checklist of questions employers can pose to their service providers to gauge how directories are maintained and how often they are refreshed.
Secretary of Labor Keith Sonderling said the guidance signals that regulators expect measurable improvement. Employers and workers seeking assistance can reach EBSA at askebsa.dol.gov or by calling 866-444-3272 toll-free. Continue reading at DOL News Releases and Briefs.
