Wyden co-sponsors bill to protect seniors from unexpected Medicare Advantage costs

WASHINGTON (KTVZ) – Sen. Ron Wyden, D-Ore., joined Sens. Michael Bennet, D-Colo., and Thom Tillis, R-N.C., in introducing legislation Wednesday to ensure Medicare Advantage plans protect seniors from unexpected health care costs and maintain accurate provider directories.

“When Americans are purchasing and using their health insurance, they have the right to know whether their doctors are covered by that plan,” Wyden said. “Too often, seniors and families get health care whiplash when they sign up for a plan only to find out that their preferred doctor is out-of-network, or it’s impossible to find a covered mental health care provider. This bipartisan legislation is a big step towards holding insurance companies accountable so their provider directories are accurate, and I’ll be working hard to get it passed.”

“We are experiencing a massive mental health crisis across America – but instead of getting the care they need, Coloradans tell me they’re struggling to find timely care,” said Bennet. “Congress urgently needs to act to improve access to mental, behavioral, and physical health care across the country. Our bipartisan bill would make it easier for Colorado seniors to find and see providers covered by their health plan.”

“Far too often, North Carolinians, especially seniors enrolled in Medicare Advantage and those in need of mental health services, find themselves unable to access the care they need due to inaccurate provider directories,” said Tillis. “This legislation ensures that consumers can access updated provider information enabling them to make informed decisions about their healthcare.” 

Many seniors enrolled in Medicare Advantage rely on their health plan’s provider directory to find in-network physicians and practitioners, but inaccurate data can make it harder to find a provider or lead to unexpected costs. These inaccurate provider directories, known as “ghost networks” often list providers which are not accepting new patients, or in some cases, are no longer in business. Ghost networks make it more difficult for patients to find in-network health care providers resulting in unexpected costs or delayed care for patients. This issue is especially pertinent in the mental and behavioral health fields. 

The Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act works to protect seniors from hidden costs and provide reliable care.

Specifically, the REAL Health Providers Act would:

• Strengthen requirements for Medicare Advantage plans to maintain accurate and updated provider directories;
• Ensure patients do not pay out-of-network costs for appointments with providers that were incorrectly listed in their plan’s provider directory as in-network; and
• Direct Centers for Medicare and Medicaid to publish guidance for plans to maintain accurate provider directories.

The text of the bill is here.

A summary of the bill is here.