Finding a doctor is as easy as, well, it depends
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In the push to get consumers to comparison-shop for health care, insurers are developing fancy online tools that help people price doctor or hospital visits and get quality information.
But for many patients, the first step with health shopping is getting a simple address and phone number from an insurer's directory of doctors. After all, if you can't find the doctors in your network, how can you comparison-shop?
Keeping doctor-directory information straight takes work, and policies for updating network directories vary from insurer to insurer. UnitedHealth Group Inc. spokesman Daryl Richard says updating provider directories is a huge task and an industrywide challenge. UnitedHealth, which relies heavily on doctors to volunteer updates, is looking for ways to improve the process. Its health-care-data subsidiary, Ingenix, early this year began a pilot program of calling doctors twice a year to verify their information, says Mr. Richard.
Humana Inc., which has more than 250,000 physicians in its network, says it makes about 50,000 updates to its doctor directory each month. But, "the information is only as good as what's given to us," says spokeswoman Mary Sellers.
We did some checking to see how well some major insurers are managing. We searched five insurers' online directories by ZIP Code (a common starting point for searches), then called the offices of the first five doctors on each list to verify the phone number and address, as well as whether the doctor is actually in the insurer's network. In some cases, we called other offices in order to avoid, for example, including two doctors in the same medical practice.
While many of the listings were correct, a good chunk of them were completely wrong. Some were more confusing than inaccurate: A common problem encountered is that multidoctor practices can have many locations, which the physicians may or may not rotate among. So searching by ZIP Code sometimes turns up a location where the doctor in question doesn't actually see patients.
First we called cardiologists in Washington, D.C., listed by UnitedHealth. Two listings were correct. A third was a number for the College Board's Educational Opportunity Center program. A fourth doctor was listed twice. Both numbers turned out to be outdated: The doctor had moved away in 2004.
We were able to reach the office of a fifth doctor, though we were told that the address listed was for the hospital where the doctor performs cardiac catheterizations -- not the office where he typically sees patients. One other issue we noticed: The doctor was a man, though UnitedHealth's list indicated he was a woman.
Mr. Richard, the UnitedHealth spokesman, says if we had done a larger, more scientific study across insurers, we would likely have found similar problems among all the companies. He says misinformation can result from reliance on doctors' offices to provide updates, as well as the fact that information comes from a variety of sources within the company, such as the physician-credentialing process.
We moved to specialists in obstetrics and gynecology listed in Brooklyn, N.Y., by Aetna Inc. When we called the number for the first doctor on the list, we reached a doctor's office but were told we had a wrong number. When we asked about the medical organization Aetna had listed with the doctor's name, we were given a different number to call, which led us to a third, this one for the doctor's true location. It turned out this doctor practiced within a group of clinics. Her actual location is in Aetna's directory, but we hadn't come across it because it wasn't in the ZIP Code we searched.
When we tried a second doctor on Aetna's list, we got what sounded like someone's personal voice mail. We left a message but never heard back. A third doctor was listed twice: One of the listings got us to the doctor's administrative office, where the doctor doesn't see patients; the other listing was correct. The number for a fourth doctor wasn't in service. The information for a fifth was correct.
"The vast majority of the information is self-reported from the provider offices," says Aetna spokeswoman Elizabeth Sell. She says Aetna solicits updated contact information from its doctors every two years, and in the interim depends primarily on doctors to provide any changes.
Next we tried listings from Cigna Corp. for doctors in family practices in San Francisco. Four doctors we tried had accurate listings. Information on a fifth doctor was basically correct, with one issue: There were two listings for the doctor, one correct, the second for an address he says he left last year.
Cigna spokeswoman Gwyn Dilday says the company updates its online directory every week, depending primarily on doctors to inform the company of any changes. As for the doctor whose address was outdated, Cigna said it had no record of any updates from his office.
Listings by Humana for dermatologists in Chicago led us to three doctors whose information was accurate, and a fourth who had changed office locations about two weeks earlier, but otherwise was listed correctly. With a fifth doctor, we got an address for a clinic within a larger health-care system for which the doctor works -- but not the location where she practices. A spokesman for the system says the system hadn't informed Humana that the doctor changed locations.
Humana calls or sends faxes to all medical providers in its network once a year, asking them for updated office information, says Ms. Sellers, the Humana spokeswoman. It normally takes about two weeks for an update from a doctor to be reflected on the insurer's online directory, she says.
Research on pediatricians listed in Las Vegas by Anthem Blue Cross & Blue Shield, a unit of WellPoint Inc. that provides coverage in Nevada, yielded four doctors whose information was correct. A fifth listing got us to the right medical practice, but we were told that the address wasn't correct for that doctor. Again it was a case of the physician belonging to a multisite practice, and the location where the doctor usually sees patients didn't turn up in the search. A spokeswoman for the insurer says it is up to the doctors to decide how they want their information listed.
Wrong Numbers
Frequently it is up to doctors to ensure that information in insurers' physician directories is accurate. Problems can include:
Searches that bring up the correct multilocation practice, but not the right location for a specific doctor.
Information that is outdated because the doctor moved and the directory hadn't been updated.
Wrong or nonworking phone numbers.
Incorrect gender listed for the physician
INSURER: Aetna
SERVICE SEARCHED: Obstetricians/gynecologists in Brooklyn, N.Y.
RESULTS: 1 correct, 2 incorrect, 2 mixed
COMMENTS: We reached one doctor's office after trying three different numbers. Another doctor had two listings, one for an administrative office where the doctor doesn't see patients.
INSURER: Anthem Blue Cross & Blue Shield in Nevada
SERVICE SEARCHED: Pediatricians in Las Vegas
RESULTS: 4 correct, 1 mixed
COMMENTS: One listing provided a location where that doctor does not usually see patients.
INSURER: Cigna
SERVICE SEARCHED: Family practices in San Francisco
RESULTS: 4 correct, 1 mixed
COMMENTS: One doctor was listed twice, with one of the addresses outdated.
INSURER: Humana
SERVICE SEARCHED: Dermatologists in Chicago
RESULTS: 3 correct, 2 mixed
COMMENTS: Two doctors' addresses were incorrect, though one had just moved two weeks before our call.
INSURER: UnitedHealth Group
SERVICE SEARCHED: Cardiologists in Washington, D.C.
RESULTS: 2 correct, 2 incorrect, 1 mixed
COMMENTS: One listing of a doctor's gender was wrong. Also, the address was for the hospital where he does procedures, not the office where he normally sees patients.
First Published August 3, 2006 12:00 am
