A bipartisan bill recently proposed by U.S. Sen. Thom Tillis (R-NC) would help prevent inaccurate provider directories known as “ghost networks” and protect seniors from unexpected healthcare costs.
The Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act, S. 3059, which Sen. Tillis cosponsored on Oct. 17 alongside bill sponsor U.S. Sen. Michael Bennet (D-CO), specifically would ensure Medicare Advantage plans maintain accurate provider directories, according to the text of the bill.
“Far too often, North Carolinians, especially seniors enrolled in Medicare Advantage and those in need of mental health services, find themselves unable to access the care they need due to inaccurate provider directories,” Sen. Tillis said on Oct. 27. “This bipartisan legislation ensures that consumers can access updated provider information enabling them to make informed decisions about their health care.”
Inaccurate data can make it harder for many senior citizens enrolled in Medicare Advantage to find in-network physicians and practitioners, leading to unexpected costs. These ghost networks are so called because some listed healthcare providers are not in a patient’s network, are not accepting new patients, or may no longer be in business, according to a bill summary provided by Sen. Tillis’ staff.
If enacted, S. 3059 would bolster requirements for Medicare Advantage plans to maintain accurate and updated provider directories; ensure patients do not pay out-of-network costs for appointments with providers that were incorrectly listed in their plan’s provider directory as in-network; and direct Centers for Medicare and Medicaid to publish guidance for plans to maintain accurate provider directories, the summary says.
Mental Health America and Inseparable support the measure, which is under consideration in the U.S. Senate Finance Committee.