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Ohio Plan Agrees To Improve Provider Lists

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Buckeye State regulators have told a health carrier to update its provider directories.

Community Insurance Company, Cincinnati, a unit of WellPoint Inc., Indianapolis, that does business as Anthem Blue Cross and Blue Shield, has signed a consent order agreeing that its on-line provider directory for mental health providers in Hamilton County, Ohio, is inaccurate and misleading, according to officials with the Ohio Department of Insurance.

The WellPoint unit has agreed to take the steps necessary to assure greater accuracy in all of its provider directories and to do so by July 1, officials say.

The Ohio department began looking into the matter when a consumer complained that many providers listed in the Anthem Blue on-line directory were unreachable, out of the company’s network, or not accepting new patients, officials say.

When department staffers called 80 of the 440 psychiatrists in the Hamilton County portion of the directory in mid-2007, they found that only 12 were reachable, in the Community Insurance network and taking new patients, officials report in the consent order.

Anthem Blue itself said it reached 42 of the 73 providers it called in January and found that 27 of those 42 providers were accepting new patients, officials report.

Anthem Blue has agreed to audit its provider directories every month, and to conduct monthly reviews of claim data for providers who have not filed claims within the previous 12 months, officials write.

The company also has agreed to have a secret shopper program test the directories, and to put a mark by the names of in-network providers who are not accepting new patients, officials write.

WellPoint representatives were not immediately available to comment on the consent order.


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