July 08, 2016

When a Good Doc Is Hard to Find: Study Suggests That Consumers Cannot Easily Get to Physician of Their Choice

Less than a third of health plan members in California are able to schedule an appointment with their preferred physician, according to a study published in Health Affairs on July 6, 2016.

The study, completed by researchers at University of Wisconsin and University of California Irvine, used two “secret shoppers” and surveyed 743 primary care providers in five of California’s 19 insurance marketplace pricing regions in the summer of 2015. The study focused on two of the largest carriers in California’s commercial market. One secret shopper presented insurance information through the state’s marketplace, while the other had a plan obtained outside the marketplace.

Both shoppers experienced similar levels of difficulty in scheduling an appointment with the originally selected physician. In 10 percent of the cases, the physician was no longer with that specific practice. In 30 percent of the cases, the wrong specialty was listed on the insurer’s network. In 20 percent of the cases, the secret shoppers were unable to reach the physician after numerous attempts, and in 10 percent of the cases, the physician was no longer accepting new patients.

While the study focused on California plans, the researchers suggest that the findings are “indicative, if not representative of the situation in much of the country.” Other recent studies also suggest considerable problems with provider directory accuracy. This study comes despite stronger CMS requirements that insurers provide up-to-date physician directories for Medicare Advantage and healthcare.gov plans.

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