{"id":253,"date":"2015-05-14T12:50:52","date_gmt":"2015-05-14T12:50:52","guid":{"rendered":"http:\/\/www.ef.panicola.com\/?p=253"},"modified":"2015-05-14T12:50:52","modified_gmt":"2015-05-14T12:50:52","slug":"nyt-out-of-pocket-cost-tool-to-be-mandated-by-hhs","status":"publish","type":"post","link":"https:\/\/www.ef.panicola.com\/?p=253","title":{"rendered":"NYT: Out of pocket cost tool to be mandated by HHS"},"content":{"rendered":"

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http:\/\/www.nytimes.com\/2015\/05\/09\/us\/politics\/health-care-law-consumer-complaints-to-get-addressed-by-white-house.html<\/p>\n

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White House Moves to Fix 2 Key Consumer Complaints About Health Care Law<\/h1>\n
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By ROBERT PEAR<\/span><\/a><\/span>

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WASHINGTON \u2014 The White House is moving to address two of the most common consumer complaints about the sale of health insurance<\/a> under the Affordable Care Act: thatdoctor directories are inaccurate<\/a>, and that patients are hit with unexpected bills for costs not covered by insurance<\/a>.<\/p>\n

Federal health officials said this week that they would require insurers to update and correct \u201cprovider directories\u201d at least once a month, with financial penalties for insurers that failed to do so. In addition, they hope to provide an \u201cout-of-pocket cost calculator\u201d to estimate the total annual cost under a given health insurance plan. The calculator would take account of premiums, subsidies, co-payments, deductibles and other out-of-pocket costs, as well as a person\u2019s age and medical needs.<\/p>\n

Since insurers began selling coverage through public marketplaces 19 months ago, many consumers and doctors have complained that the physician directories are full of inaccuracies. \u201cThese directories are almost out of date as soon as they are printed,\u201d said Kevin J. Counihan, the chief executive of the federal insurance marketplace.<\/p>\n

Medicare<\/a> and Medicaid<\/a> officials have found similar problems in the directories of insurance companies that manage care for beneficiaries of those programs. In December, federal investigators said that more than a third of doctors listed as participating in Medicaid plans could not be found at the locations listed.<\/p>\n

The Obama administration recently adopted stricter standards stating that each insurer in the federal marketplace \u201cmust publish an up-to-date, accurate and complete provider directory, including information on which providers are accepting new patients, the provider\u2019s location, contact information, specialty, medical group and any institutional affiliations.\u201d<\/p>\n

In addition, Mr. Counihan said, the administration will require insurers to provide physician information in a format that software developers can use to create tools to help consumers find health plans in which their doctors participate. Consumer advocates like Robert M. Krughoff, the president of the Center for the Study of Services, also known as Consumers\u2019 Checkbook, said such tools could be a boon to consumers.<\/p>\n

The new standards significantly strengthen an earlier rule, which required insurers to publish directories online and to make paper copies available on request. In the federal exchange, violations are subject to civil penalties of up to $100 a day for each person adversely affected.<\/p>\n

Federal officials said that inaccurate provider directories could be a sign of larger problems. If doctors listed in a directory are not available or are not taking new patients, consumers may not have access to covered services, and the insurers may not meet federal standards for \u201cnetwork adequacy,\u201d the officials said. Consumers must often pay extra when they use doctors outside the network of their health plan, so an inaccurate directory could also lead to higher costs for patients.<\/p>\n

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Moreover, doctors said that they too need accurate directories so they can refer patients to physicians in the network when specialized treatment is required.<\/p>\n

\u201cThe impact of inaccurate provider directories on consumers can be devastating, especially on those consumers who need to carefully examine networks for specific subspecialists, cancer<\/a> centers or children\u2019s hospitals,\u201d the American Medical Association told state insurance officials in a recent letter endorsed by dozens of health care provider and patient groups.<\/p>\n

But insurers say that the problems might not be easy to fix, and that doctors are partly to blame for the directory errors. Insurers \u201care unable to guarantee the accuracy of the provider\u2019s status\u201d in a directory because doctors often \u201cstop accepting particular health plans\u2019 members off and on throughout the year and fail to notify the plan in a timely manner,\u201d America\u2019s Health Insurance Plans, the chief lobby for the industry, said in a letter to the Obama administration.<\/p>\n

In its online doctor directory, Blue Cross and Blue Shield of Texas says that it makes every effort to provide correct information, but that it \u201ccannot be responsible for omissions or errors in the provider details.\u201d Aetna says that data in its directory is \u201csubject to change at any time.\u201d UnitedHealth tells Medicare beneficiaries, \u201cA doctor listed in the directory when you enroll in a plan may not be available when your benefits become effective.\u201d<\/p>\n

The problems that consumers face with unexpected costs may result, in part, from the way plans are listed on HealthCare.gov, the website for the federal marketplace. More than 8.5 million people are in private health plans selected through the site, and the plans are listed in order of their premiums, from lowest to highest.<\/p>\n

This encourages consumers to focus on premiums rather than total costs, said Mr. Krughoff, the Consumers\u2019 Checkbook president, and they often spend hundreds or thousands of dollars more than they need to.<\/p>\n

Mr. Krughoff\u2019s group has been publishing a guide to health plans for federal employees for more than 30 years, and a version of its online tool<\/a>for comparing health plans is available on the website of the federal marketplace in Illinois. \u201cIt\u2019s been a great tool,\u201d said Jose M. Mu\u00f1oz, a spokesman for Get Covered Illinois, the state agency that promotes enrollment.<\/p>\n

The tool can perform searches tailored to a person\u2019s needs and priorities. It asks consumers to describe their health status, offering five levels from excellent to poor, and to list \u201cexpected medical procedures\u201d like childbirth,knee replacement<\/a> or prostate removal<\/a>. It also provides an estimate of total yearly costs for the user.<\/p>\n

Federal officials said that they might link HealthCare.gov to an out-of-pocket cost calculator later this year, and that they hoped to make such comparisons a standard part of the shopping experience at the site in later years.<\/p>\n

\u201cWe know that we have work to do to make it easier for consumers to find plans that meet their needs,\u201d said Lori Lodes, a spokeswoman at the Centers for Medicare and Medicaid Services, which runs the federal marketplace serving more than 30 states.<\/p>\n

A few state-run exchanges are developing similar tools. Peter Nichol, the information technology director for the state insurance exchange in Connecticut, said it would add a \u201ccost calculator\u201d to its website this summer.<\/p>\n

The Obama administration is also taking steps to increase the accuracy of doctor directories in Medicare. About 30 percent of the 55 million beneficiaries are in private Medicare Advantage plans that typically use networks of doctors to care for patients.<\/p>\n

The Medicare agency said it had received complaints about insurance company directories that included doctors who \u201chave retired from practice, have moved locations or are deceased.\u201d New federal rules will require insurers to update their Medicare directories each month, \u201cwith specific notations to highlight those providers who are closed or not accepting new patients.\u201d<\/p>\n