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Study: Medicare Advantage networks include many docs that aren't available


Medicare Advantage insurers "substantially overestimate" how many in-network dermatologists can treat patients in several different markets. Many of the doctors weren't actually available--including some that are dead, retired or not accepting new patients, according to a new study published in the Journal of the American Medical Association Dermatology.

The study authors analyzed more than 4,700 physician directories for dermatologists who were listed as being in network for various Medicare Advantage plans. They determined that 45 percent of the doctors listed in plans' provider directories were duplicates.

Of the unique listings, almost 51 percent of the doctors weren't available, either because they were unreachable (18 percent), weren't accepting new patients (9 percent), or were deceased, retired or had moved (9 percent).

In total, less than half of the dermatologists (1,266 doctors) were reachable, accepted the specific Medicare Advantage plan and offered an appointment.

"I think it just identifies a big area that needs a lot of help to increase transparency to patients," lead author Jack Resneck, Jr., who works with the University of California, San Francisco, told Reuters. "Across the board, nobody scored that well here."

The problem isn't limited to just dermatologists. Many enrollees who bought coverage through the health insurance exchanges are having a hard time finding doctors willing to accept them as patients, FierceHealthPayer previously reported.

But Clare Krusing, director of communications for America's Health Insurance Plans, defended insurers. "There is a shared responsibility between providers and health plans to ensure seniors have access to the care and resources they need when it comes to their healthcare choices," she told Reuters. "Greater transparency on the part of those specialists participating in provider networks is critical to making this happen."

To learn more:
- here's the JAMA Dermatology study
- read the Reuters article

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Do state officials have authority over Medicare Advantage insurers?
Are stricter network standards coming for exchange plans?
California officials scrutinizing narrow networks