Aetna settles with state over ‘ghost networks’
Health insurer Aetna has agreed to vastly improve information for consumers, after an investigation by the Massachusetts attorney general found that its provider directories are inaccurate and deceptive.
The office filed a settlement agreement in Suffolk Superior Court Tuesday, closing its investigation into the company. Aetna has a relatively small presence in Massachusetts, insuring about 170,000 residents.
Health plan members rely on insurance company directories to identify doctors, psychologists, and other medical providers who are in the plan’s network, are accepting new patients, and work nearby. Insurers tout the directories as a tool to help consumers find doctors — and convince them to sign up with their plan.
But consumers have long complained about “ghost networks,’’ particularly when it comes to mental health care. They call the provider listed, and are told that the doctor has retired or moved, closed to new patients, or that the phone number is simply wrong.
Attorney General Maura Healey’s office said it uncovered a host of problems with Aetna’s directories, including listing doctors “at locations where they do not actually provide health care services.’’
The company agreed to a range of improvements, including updating information within 30 days of being alerted to an inaccuracy — even if that red flag comes from a member complaint. Aetna also must ask providers to update their information four times year.
Aetna will take more extensive transparency measures for its behavioral health care directories, including monthly audits. Under terms of the agreement, if they are 98 percent accurate for three consecutive months, the company can conduct the audits quarterly instead.
“Moving forward, we will take a number of steps to improve the quality of our provider directories to ensure that our members have access to the correct contact information for the health care professionals in their network,’’ said spokesman Ethan Slavin in a statement.