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One of the most acute issues facing dermatologists is the implementation of narrow networks by health insurers. Inaccurate physician rosters have long been a problem that insurers have been indifferent to, but this was not an acute problem since almost all providers were included in the networks.
However, the recent “ramp up” because of increased costs and cuts associated with the Affordable Care Act (ACA) has resulted in the delisting of many thousands of physicians (including hundreds of dermatologists) from insurance plans and refusal to allow them to enroll in new plans. All in a time of physician shortages and an acute shortage of dermatologists.
When I was president of the American Academy of Dermatology, I made it a priority that patients and the government, who pay or subsidize insurance companies for this hollow insurance, understand how they were being cheated on their health care dollars – or, as we say in Kentucky, being sold a “pig in a poke.” A pig in a poke is a pig (or another small farm animal) carried to market in a bag with only the head sticking out, disguising the skinny product within.
The AAD staff and I went to the White House, Congress, the Centers for Medicare and Medicaid Services (CMS), AHIP (America’s Health Insurance Plans trade association), PhRMA (Pharmaceutical Research and Manufacturers of America), and the Medicare Payment Advisory Commission (MedPac); and spoke to the Office of Inspector General (OIG), which agreed to investigate. We and the dermatology patient advocacy groups organized a letter writing campaign and solicited letters and complaints from members. We contacted the state health insurance commissioners and testified at their hearings. Our fellow dermatologist and AMA board of trustee member Jack Resneck, MD, researched and wrote an article in JAMA Dermatology, demonstrating how pathetically inaccurate the insurance company physician networks are (2014;150[12]:1290-7). We beat the drum loud and long, and it worked!
The OIG issued a scathing report about the lack of follow through by CMS on billions of health care dollars being paid by the federal government to Medicare Advantage plans. CMS agreed with their report, and agreed to investigate. A CMS survey reported in October 2016 that almost half of the doctor listings in their Medicare Advantage (Humana, Aetna, United, and Anthem senior plans) directories contained incorrect information, including inaccurate names and addresses; multiple, duplicate listings; and doctors who have died. CMS concluded that they expect this performance to improve over the next three study periods – or they will start to assess $25,000 a day in penalties.
Also published last year, a “secret shopper” survey of primary care providers in five insurance marketplace pricing regions found that fewer than 30% of consumers were able to schedule an appointment with the physician they had first selected (Health Aff [Millwood]. 2016 Jul 1;35[7]:1160-6).
Folks, the only way to improve the accuracy is to delete duplicated listings, delete physicians no longer seeing new patients, delete physicians incorrectly listed, and delete those who have died or moved on. We have to continue this effort on a state by state level, or insurers will quickly backslide, because if there are no doctors to see, there are no bills for them to pay.
Accurate rosters will reveal huge gaps in their directories, and insurers will be forced to recontract with delisted physicians. Physicians should watch for and anticipate this, and should not sign up at a disadvantage. Patients must continue to pressure their health insurers both personally and through their human resources departments at work. No one should have to buy “a pig in a poke.” This is huge national victory, for patients and physicians. Dermatologists, you should be proud of your AAD leading the charge, and following through on getting this issue addressed and fixed.
Dr. Coldiron is a past president of the American Academy of Dermatology. He is currently in private practice, but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics.
One of the most acute issues facing dermatologists is the implementation of narrow networks by health insurers. Inaccurate physician rosters have long been a problem that insurers have been indifferent to, but this was not an acute problem since almost all providers were included in the networks.
However, the recent “ramp up” because of increased costs and cuts associated with the Affordable Care Act (ACA) has resulted in the delisting of many thousands of physicians (including hundreds of dermatologists) from insurance plans and refusal to allow them to enroll in new plans. All in a time of physician shortages and an acute shortage of dermatologists.
When I was president of the American Academy of Dermatology, I made it a priority that patients and the government, who pay or subsidize insurance companies for this hollow insurance, understand how they were being cheated on their health care dollars – or, as we say in Kentucky, being sold a “pig in a poke.” A pig in a poke is a pig (or another small farm animal) carried to market in a bag with only the head sticking out, disguising the skinny product within.
The AAD staff and I went to the White House, Congress, the Centers for Medicare and Medicaid Services (CMS), AHIP (America’s Health Insurance Plans trade association), PhRMA (Pharmaceutical Research and Manufacturers of America), and the Medicare Payment Advisory Commission (MedPac); and spoke to the Office of Inspector General (OIG), which agreed to investigate. We and the dermatology patient advocacy groups organized a letter writing campaign and solicited letters and complaints from members. We contacted the state health insurance commissioners and testified at their hearings. Our fellow dermatologist and AMA board of trustee member Jack Resneck, MD, researched and wrote an article in JAMA Dermatology, demonstrating how pathetically inaccurate the insurance company physician networks are (2014;150[12]:1290-7). We beat the drum loud and long, and it worked!
The OIG issued a scathing report about the lack of follow through by CMS on billions of health care dollars being paid by the federal government to Medicare Advantage plans. CMS agreed with their report, and agreed to investigate. A CMS survey reported in October 2016 that almost half of the doctor listings in their Medicare Advantage (Humana, Aetna, United, and Anthem senior plans) directories contained incorrect information, including inaccurate names and addresses; multiple, duplicate listings; and doctors who have died. CMS concluded that they expect this performance to improve over the next three study periods – or they will start to assess $25,000 a day in penalties.
Also published last year, a “secret shopper” survey of primary care providers in five insurance marketplace pricing regions found that fewer than 30% of consumers were able to schedule an appointment with the physician they had first selected (Health Aff [Millwood]. 2016 Jul 1;35[7]:1160-6).
Folks, the only way to improve the accuracy is to delete duplicated listings, delete physicians no longer seeing new patients, delete physicians incorrectly listed, and delete those who have died or moved on. We have to continue this effort on a state by state level, or insurers will quickly backslide, because if there are no doctors to see, there are no bills for them to pay.
Accurate rosters will reveal huge gaps in their directories, and insurers will be forced to recontract with delisted physicians. Physicians should watch for and anticipate this, and should not sign up at a disadvantage. Patients must continue to pressure their health insurers both personally and through their human resources departments at work. No one should have to buy “a pig in a poke.” This is huge national victory, for patients and physicians. Dermatologists, you should be proud of your AAD leading the charge, and following through on getting this issue addressed and fixed.
Dr. Coldiron is a past president of the American Academy of Dermatology. He is currently in private practice, but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics.
One of the most acute issues facing dermatologists is the implementation of narrow networks by health insurers. Inaccurate physician rosters have long been a problem that insurers have been indifferent to, but this was not an acute problem since almost all providers were included in the networks.
However, the recent “ramp up” because of increased costs and cuts associated with the Affordable Care Act (ACA) has resulted in the delisting of many thousands of physicians (including hundreds of dermatologists) from insurance plans and refusal to allow them to enroll in new plans. All in a time of physician shortages and an acute shortage of dermatologists.
When I was president of the American Academy of Dermatology, I made it a priority that patients and the government, who pay or subsidize insurance companies for this hollow insurance, understand how they were being cheated on their health care dollars – or, as we say in Kentucky, being sold a “pig in a poke.” A pig in a poke is a pig (or another small farm animal) carried to market in a bag with only the head sticking out, disguising the skinny product within.
The AAD staff and I went to the White House, Congress, the Centers for Medicare and Medicaid Services (CMS), AHIP (America’s Health Insurance Plans trade association), PhRMA (Pharmaceutical Research and Manufacturers of America), and the Medicare Payment Advisory Commission (MedPac); and spoke to the Office of Inspector General (OIG), which agreed to investigate. We and the dermatology patient advocacy groups organized a letter writing campaign and solicited letters and complaints from members. We contacted the state health insurance commissioners and testified at their hearings. Our fellow dermatologist and AMA board of trustee member Jack Resneck, MD, researched and wrote an article in JAMA Dermatology, demonstrating how pathetically inaccurate the insurance company physician networks are (2014;150[12]:1290-7). We beat the drum loud and long, and it worked!
The OIG issued a scathing report about the lack of follow through by CMS on billions of health care dollars being paid by the federal government to Medicare Advantage plans. CMS agreed with their report, and agreed to investigate. A CMS survey reported in October 2016 that almost half of the doctor listings in their Medicare Advantage (Humana, Aetna, United, and Anthem senior plans) directories contained incorrect information, including inaccurate names and addresses; multiple, duplicate listings; and doctors who have died. CMS concluded that they expect this performance to improve over the next three study periods – or they will start to assess $25,000 a day in penalties.
Also published last year, a “secret shopper” survey of primary care providers in five insurance marketplace pricing regions found that fewer than 30% of consumers were able to schedule an appointment with the physician they had first selected (Health Aff [Millwood]. 2016 Jul 1;35[7]:1160-6).
Folks, the only way to improve the accuracy is to delete duplicated listings, delete physicians no longer seeing new patients, delete physicians incorrectly listed, and delete those who have died or moved on. We have to continue this effort on a state by state level, or insurers will quickly backslide, because if there are no doctors to see, there are no bills for them to pay.
Accurate rosters will reveal huge gaps in their directories, and insurers will be forced to recontract with delisted physicians. Physicians should watch for and anticipate this, and should not sign up at a disadvantage. Patients must continue to pressure their health insurers both personally and through their human resources departments at work. No one should have to buy “a pig in a poke.” This is huge national victory, for patients and physicians. Dermatologists, you should be proud of your AAD leading the charge, and following through on getting this issue addressed and fixed.
Dr. Coldiron is a past president of the American Academy of Dermatology. He is currently in private practice, but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics.