US Department of Labor issues guidance to employers, plan fiduciaries on inaccurate health network provider directories

News Release

US Department of Labor issues guidance to employers, plan fiduciaries on inaccurate health network provider directories

WASHINGTON - As part of its effort to protect workers, retirees, and their families, the U.S. Department of Labor today issued an enforcement alert to help employers and plan fiduciaries ensure plan participants and beneficiaries are receiving accurate provider directories for in-network coverage.

Health plans and insurance issuers are required under the Employee Retirement Income Security Act to regularly verify, update, and publish accurate provider directory information. The enforcement alert provides best practices and questions to ask so that participants and beneficiaries are protected from unexpected out-of-network costs and receive quicker access to care from in-network providers.

"President Trump is committed to improving the quality and lowering the cost of healthcare for all hardworking Americans. With this guidance, the U.S. Department of Labor is letting health plans and insurance issuers know that they must do better," said Secretary of Labor Keith Sonderling. "They must provide accurate and updated information so that American workers, retirees, and their families can make informed healthcare decisions. I am proud to lead this effort on their behalf."

The alert follows a secret shopper survey conducted by the department's Employee Benefits Security Administration where the agency called over 27,000 providers across 27 networks and found 36% of provider directory information was incorrect. Inaccurate directory information can lead to delays in care, higher out-of-pocket costs, and sometimes result in individuals foregoing treatment if they are unable to find in-network providers.

"Workers, retirees, and their families rely on their employer-sponsored healthcare to have a robust network of providers. Yet, all too often, network directories provide inaccurate information, such as including doctors that are out of network, leading to delays in care or increased costs," said Assistant Secretary of Labor for the Employee Benefits Security Administration Daniel Aronowitz. "Today the Trump Administration is giving employers and plan fiduciaries clear guidance on how to ensure network directories are updated and accurate, so health plan participants and beneficiaries have access to the meaningful care they deserve when they need it most."

The enforcement alert provides information for employers and fiduciaries that want to improve directory accuracy, including:

• Explaining statutory requirements, including fiduciary responsibilities and the No Surprises Act, as related to the maintenance and update of provider directories.
• Highlighting more findings from EBSA's secret shopper survey of provider directories.
• Providing questions to ask service providers to better understand directory updates and maintenance.

EBSA also developed a metric to evaluate whether participants could successfully rely on directory information to access care. The "pathway to service metric" looked at whether providers could be contacted, if they were in-network, and were accepting and seeing new patients within 30 days. Sixty-six percent of medical and surgical providers did not meet all these criteria, and 74% of mental health and substance use disorder providers did not meet all these criteria.

Employers and workers can contact EBSA at askebsa.dol.gov or call 866-444-3272 toll-free for help with private sector job-based retirement and health plans.

Read the enforcement alert to learn more.