REAL Health Providers Act
Senate Committee Targets Medicare Advantage 'Ghost Networks' With Required Doctor Directory Audits
Legislative Progress
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a doctor's information, they must clearly label that listing in the directory so patients know the details might be out of date.
Impact Analysis
Personal Impact
Life & Work
Small medical practices and provider offices will face new administrative requirements to respond to directory verification requests from Medicare Advantage plans every 90 days. While the bill instructs the government to issue guidance on reducing this burden and explore data standardization, the verification process still adds work for small healthcare businesses already stretched thin on administrative staff.
Programs
Disabilities
Milestones
Read twice and referred to the Committee on Finance.
Sent to a congressional committee for expert review. The committee decides whether this bill moves forward.
Introduced in Senate
The bill was officially filed and given a number. It now enters the legislative queue.
Votes
No votes have been recorded for this legislation yet.
Related News
5 articles
American Psychiatric Association Sues Health Plan Over 'Ghost Networks'
A provision in the 2026 appropriations bill passed this week requires Medicare Advantage plans to maintain accurate provider directories beginning in 2028 and report on accuracy. This follows a lawsuit against EmblemHealth for 'ghost networks' that mislead patients seeking mental health care.
New Bill Aims to Cut Down on Behavioral Health 'Ghost Networks'
The REAL Health Providers Act, introduced by a bipartisan group of senators, would strengthen requirements for Medicare Advantage plans to maintain accurate directories. It aims to protect seniors from 'ghost networks' where listed providers are no longer in-network or accepting patients.
MedPAC Tackles Accuracy of Medicare Advantage Network Directories
MedPAC members discussed the 'horrible' and 'unfair' situations caused by inaccurate Medicare Advantage directories. The commission is analyzing network requirements to recommend how changes in directory rules could better serve beneficiaries and prevent patients from being stranded.
Source Information
Document Type
Congressional Bill
Official Title
REAL Health Providers Act
Data Sources
Sponsor
Cosponsors
(2)Analysis generated by AI. Always verify with official sources.