Insurance carrier to repay patients, fix provider directory in NY settlement

MVP Health Plan is a nonprofit organization based in Schenectady, New York, that provides and administers health coverage for fully insured small groups, fully insured large groups and self-insured employer health plans in New York state and Vermont, in addition to providing individual and family coverage through Medicaid, Medicare and the Affordable Care Act public exchange program.

New York's corrective action plan calls for MVP to pay a $250,000 penalty, provide restitution for enrollees hurt by inaccurate provider directory listings, and overhaul its efforts to update its provider directory.

MVP is supposed to update listings within 15 days of receiving new information and delete entries for providers who are not accepting new patients or who fail to respond to entry verification requests, officials said.

New York Attorney General Letitia James announced an effort to fight inaccuracies in health plan mental health care provider directory listings in 2023.

When James began the investigation, she called inaccurate mental health care provider entries a symptom of a health system that's failing to provide adequate access to care.

"When families turn to their health plans for help, they should be able to trust that the information they are given is reliable, and that they can access care without unnecessary obstacles," James said in an announcement about the MVP corrective action plan.

MVP's response: MVP said in a statement that it's committed to delivering a health care experience that members can trust, including timely access to high-quality mental health services.

"We recognize that navigating the health care system can sometimes be challenging, and we are taking decisive steps to make it easier for our members to find the care they need when they need it," MVP said.

MVP said it has implemented a comprehensive plan to strengthen the accuracy of its provider directories, enhance transparency, and expand access to behavioral health care.

"This includes enhanced verification of provider information, new tools to assist members in locating care, and continued investment in telehealth and digital platforms to broaden access to services," the company said.

Going forward, MVP will verify behavioral health provider information every 90 days, update listings within 15 days of any reported change, and maintain detailed logs of additions and removals, the company said.

The backdrop: Patients, employers and benefits advisors have complained for decades about problems with health plan provider entry accuracy.

Federal law now requires plans to correct inaccurate directory entries within 90 days.

But people with mental health problems and their families have argued that "ghost providers" are still common in the listings for providers who help with mental health problems, such as psychologists, social workers and psychiatrists.

Related: Patients sue Elevance over mental health provider 'ghost network'

In 2024, California lawmakers came close to passing a bill that would have required plans there to maintain a 95% provider directory accuracy level or pay fines of $500 to $5,000 per 1,000 enrollees affected. Lawmakers ended up letting the bill die after health plans said it could expose plans to huge fines over typos.

Investigators in Pennsylvania reviewed provider directories there and reported that only 38% of plans were removing inaccurate entries within a year.