Oct 27 2023

WASHINGTON, D.C Senators Thom Tillis, Ron Wyden (D-OR) and Michael Bennet (D-CO) recently introduced the bipartisan Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act to ensure Medicare Advantage plans maintain accurate provider directories and protect seniors from unexpected healthcare costs. 

“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,” said Senator Tillis. “This bipartisan legislation ensures that consumers can access updated provider information enabling them to make informed decisions about their healthcare.” 

Many seniors enrolled in Medicare Advantage rely on their health plan’s provider directory to find in-network physicians and practitioners, but inaccurate data can make it harder to find a provider or lead to unexpected costs. These inaccurate provider directories are known as “ghost networks” because some listed healthcare providers are not in a patient’s network, are not accepting new patients, or, in some cases, are no longer in business. Ghost networks make it more difficult for patients to find in-network healthcare providers, a more acute issue in the mental and behavioral health fields, resulting in unexpected costs or delayed patient care.

Specifically, the REAL Health Providers Act would:

  • Strengthen 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.

“In the midst of a mental health and substance use crisis, people need to easily and quickly access the help they need. The federal government pays Medicare Advantage plans to provide timely services, but their inaccurate provider directories lead to frustration, financial hardship, delay, and denial of care. MHA supports this bill as an important step forward in addressing this persistent problem that causes so much harm to people with mental health and substance use conditions and their families,” said Mary Giliberti, Chief Public Policy Officer, Mental Health America (MHA).

“Inaccurate provider directories may sound innocuous, but they prevent people from getting treatment or stick them with surprise bills for out-of-network care. Inseparable applauds Senators Bennet (D-CO) and Tillis (R-NC) for their bipartisan collaboration on this bill that will help protect people from those unfair charges,” said Bill Smith, Founder and President, Inseparable.

Text of the bill is available HERE. A summary of the bill is available HERE.