REAL Health Providers Act

Key Points

• This bill requires Medicare Advantage plans to keep their lists of doctors and hospitals up to date. Starting in 2028, insurance companies must check their directory information every 90 days to ensure patients have the correct phone numbers, addresses, and details on whether a doctor is still accepting new patients.
• The policy protects seniors and people with disabilities from 'ghost networks'—lists that include doctors who are no longer in the plan. If a patient schedules an appointment with a doctor listed as 'in-network' who turns out to be out-of-network, the insurance company must limit the patient's bill to the lower, in-network price.
• Insurance companies will be required to perform annual audits of their directories and report an 'accuracy score' to the government. These audits must specifically look at areas where errors are common, such as mental health and substance use disorder treatment providers.
• To help people choose the best insurance, the government will begin posting these accuracy scores online in 2029. This allows families to see which plans have the most reliable information before they sign up for coverage during the yearly open enrollment period.
• Plans must remove doctors from their online lists within five business days of learning they are no longer in the network. If the company cannot verify a doctor's information, they must clearly label that listing in the directory so patients know the details might be out of date.