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Originally published November 18, 2013 at 6:35 PM | Page modified November 19, 2013 at 6:48 PM

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Doctors, hospitals catch goofs on state insurance exchange

The feature that lists which health-care providers are in a plan’s network has been plagued with errors since the website’s launch in October.


Special to The Seattle Times

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The Washington Healthplanfinder insurance exchange has a feature on its website that allows consumers to see if particular doctors and hospitals are in a plan’s network of health-care providers.

The provider directory is to help consumers compare plans on more than just price. The idea is that consumers who want to keep their doctor should be able to find out which plans allow them to do so.

But the directory has been plagued with errors since the website was launched six weeks ago.

The most serious problems have included listing some doctors and hospitals as outside a plan’s network when they are actually in it. This has caused confusion for some consumers trying to choose a plan that includes their doctor or preferred hospital.

Hospitals and physician groups have been busy trying to catch the mistakes and tell the Washington Health Benefit Exchange, which operates Healthplanfinder, to correct the errors. For its part, the exchange acknowledges there are errors and advises consumers to double-check the information on its website with the insurers.

Michele Fisher, director of contracting at University of Washington Medicine, said her staff has spent a good deal of time searching through the directory looking for errors in how UW hospitals and physicians are listed.

“Three of us spent about 10 hours here one weekend just trying to find the low-hanging fruit,” said Fisher. “We were looking for the big stuff we could pull out.”

Among the “big stuff” they found was that all UW hospitals and physicians were listed as out of network for Molina Healthcare of Washington, one of the insurers selling plans through the exchange for coverage in 2014.

Molina’s network actually includes all UW hospitals and doctors, Fisher said.

They also found that one of UW’s affiliated hospitals, Valley Medical Center in Renton, was listed incorrectly as being out of network for BridgeSpan, an affiliate of Regence BlueShield and another insurance carrier on the exchange.

BridgeSpan’s network for its exchange plans includes all UW physicians and hospitals, including Valley.

Fisher said she and her staff made it a priority to get these errors corrected.

“We didn’t want patients going in and not choosing BridgeSpan because they thought Valley wasn’t in their network,” she said. “Our entire goal is not to misrepresent to patients what is available to them.”

Fisher and her staff have found other mistakes as well.

For the first month the exchange was open, Healthplanfinder’s provider directory incorrectly described the UW Medical Center and Harborview Medical Center as psychiatric hospitals, Fisher said.

“I don’t know how that happened,” she said, “but I do know it’s been fixed.”

There also have been errors in the contact information listed for UW physicians. Doctors find these errors on their own, or have them pointed out by patients, and send emails about the mistakes that end up in Fisher’s inbox.

In Fisher’s view, the system for putting information into the exchange’s directory leaves significant room for error.

Providers can make mistakes in the contact information they send to the carriers, for instance, and carriers can make mistakes when staff manually put provider data into their systems.

But some errors can be traced back to the exchange.

A contractor hired to upload provider information to the website ran into problems, said exchange communications director Michael Marchand.

“We found that the initial contractor upload of provider data had some inconsistencies with the directory,” said Marchand. “We immediately went to work to resolve those issues.”

Sometimes there are errors in the provider directory because it takes time to update the information to reflect the current state of contracts between providers and insurers.

Some hospitals and physician groups reached agreements with insurers after the exchange website went live Oct. 1.

The Polyclinic reached an agreement with Premera and LifeWise (a Premera subsidiary) after the provider information was initially loaded into the exchange website. As a result, all its physicians were listed incorrectly as out of network for those insurers until Nov. 1, when the website information was updated.

The Polyclinic discovered that the new information was not on the website after a patient posted a question to its Facebook page asking if there really was only one health plan on the exchange that included its physicians in-network, said Tracy Corgiat, Polyclinic vice president of marketing and development.

“We went to the Healthplanfinder site to do an audit and discovered the error,” said Corgiat. “I called the exchange, and we ended up sending them a list of all our providers and asked them to ensure that each showed as in-network for the three plans.”

The exchange staff made the corrections as part of its Nov. 1 update, and now all of Polyclinic’s physicians are listed correctly, Corgiat said.

But just as some errors get fixed, new ones are discovered.

Recently, an in-person assister was helping patients at the UW Neighborhood Clinic in Woodinville with their applications on Healthplanfinder and discovered that all five primary-care physicians at the clinic were listed as out of network for BridgeSpan.

A week earlier, those doctors had been listed, correctly, as part of BridgeSpan’s network, Fisher said.

Marchand acknowledges the directory contains errors. “As with any directory — online or in print — there will be differences between what is displayed and is in practice,” he said in an email.

Marchand noted that the Healthplanfinder website advises consumers to double-check the provider information they see on the site.

A consumer who looks up a specific provider will get a disclaimer that states, “We cannot guarantee that a doctor or facility will still participate in your plan’s network or accept new patients on or after the effective date of your coverage. To confirm their participation please contact the health care provider directly.”

Insurers also are urging consumers to check with them.

Exchange staff have been auditing the data in the directory and are working with providers to correct discrepancies, Marchand said.

The exchange asks that anyone with questions about this issue email its staff at QHP@wahbexchange.org.

But in some cases, Marchand said, “the physicians need to follow up directly with the carrier to understand why they are not showing in their network or information is not correct.”

Amy Snow Landa is a freelance writer in Seattle. This story was produced through a partnership with Kaiser Health News, an editorially independent part of the Kaiser Family Foundation, a health-policy research and communication organization that is not affiliated with Kaiser Permanente.



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