SB 302: Provider Directory Improvement Act
Horizons in Hemophilia, Summer, 2016
by Nichelle Sims, J.D., Associate Director of Research and Advocacy
The 2016 legislative session has concluded, and we are celebrating the passage of SB 302: The Provider Directory Improvement Act. This act will make selecting an insurance plan easier for Georgia consumers. Provider directories play a vital role in informing consumers and patients which doctors participate in various networks and plans, thereby helping consumers chose doctors that are in-network and available to them. Yet, most of the time consumers find the directory information outdated or unreliable. Inaccurate provider directories have been commonplace since changes are not reported or proactively inquired about, and there are no regular audits to update or remove outdated information. Furthermore, insurers are not held accountable for inaccurate information that leads to surprise billing for consumers from using out-of-network providers.
Thankfully, SB 302 will solve these problems in Georgia by establishing basic standards for health insurance provider directories and protections for the consumers and patients who depend on them. In short, the bill requires all health plans to:
- Post on their websites accurate directories for each plan in a standardized, downloadable and searchable format that is available to the general public through an easy-to-use link;
- Update directories every 30 days;
- Provide a dedicated email address and phone number that consumers can use to report inaccuracies, as well as a process to address complaints and correct errors;
- Conduct an annual audit of all directories with a protocol in place for insurers to follow-up with providers to determine their network participation status and update the health plans accordingly; and
- Honor provider directory information even if it is inaccurate and a consumer ends up out-of-network based on that information.
With the rollout of these new requirements on provider directories in the coming months, consumers should feel reassured knowing that they are making informed decisions based on accurate information and that they will not be penalized for directory inaccuracies. We hope consumers will report having a much more positive experience when locating and navigating provider directories.
The passage of SB 302 is a significant step towards provider directory accuracy and accessibility that will allow consumers to make the best health care decisions for themselves and their families.