NY Health Insurers Settle With Attorney General on Accuracy of Online Provider Directories

Several health insurers in New York have reached settlements with the state's attorney general that require them to ensure their online provider directories are accurate by removing providers who no longer participate in their network and fixing listing errors for providers who do participate.

Reaching agreements with Attorney General Eric T. Schneiderman were Empire HealthChoice HMO Inc. and Empire HealthChoice Assurance Inc., units of WellPoint Inc. (NYSE: WLP); Health Insurance Plan of Greater New York and HIP Insurance Company of New York; United HealthCare of New York Inc., United HealthCare Insurance Company of New York and Oxford Health Plans of New York, units of UnitedHealth Group (NYSE: UNH), and Vytra Health Plans.

The settlements also require the companies to pay restitution to members who paid more than they should have because they visited providers that their insurers erroneously listed as in-network.

"Empire is about doing the right thing for our customers, so we strongly support the improved and more frequent processes cited in the AG's release and have already begun implementing and changes that weren't already in place," Sally Kweskin, a spokeswoman for Empire Blue Cross Blue Shield, said in an email.

The companies have agreed to, among other things, update their online provider directories within 30 days of receiving verified provider information going forward and track changes; refund consumers for amounts paid for services rendered by nonparticipating providers who were listed in the online provider directory when they received services; and collectively pay $60,000 to cover the attorney general's costs of the investigation.

The attorney general's office started the investigation after receiving complaints from plan members and providers through its Health Care Bureau Helpline. It uncovered inaccurate listings that delayed access to medical care by forcing members to find another physician after discovering, through a phone call or sometimes upon arriving at an appointment, that their physician was no longer participating in the plan.

In December 2010, the attorney general reached settlements with Aetna (NYSE: AET), Cigna (NYSE: CI), GHI, and with Magnacare and Multiplan Inc.—companies that created networks of doctors and other providers and leased the networks to insurers for them to use as their participating providers. Those settlements also required the network companies to fix online directories they provide insurers and to reform their practices.

HIP Health Plan of New York and Group Health Inc. are subsidiaries of Emblem Health Inc.

"Inaccurate directories lead to delays in care and additional costs to the consumer, particularly when that consumer winds up seeing a doctor who is not actually a provider in the plan and pays out of pocket," Schneiderman said in a statement.

(By Fran Matso Lysiak, senior associate editor, BestWeek: [email protected])