Provider directory errors cause patients to unknowingly see out-of-network doctors

Insurer online provider directories list physicians as in-network and accepting patients when they have actually left the network, moved practices, or retired, leading patients to book appointments and receive care under the false assumption of in-network coverage. The patient only learns the provider was out-of-network when they receive a bill 4-8 weeks later, sometimes for thousands of dollars, and their only recourse is a lengthy appeals process with a low success rate. A CMS secret shopper study found that 52% of provider directory listings contained at least one inaccuracy. This persists because insurers face no financial penalty for directory errors under most state laws, directory updates depend on providers self-reporting changes, and there is no shared national credentialing database that syncs in real time.