A provider is a licensed doctor, hospital, facility or other health care professional that provides services to you. Each network has a listing of participating providers in a “provider directory.” These directories are available in paper form or online. New rules require that carriers keep their provider directory up-to-date so that you don’t end up with a surprise bill from an out-of-network provider that you thought was an in-network provider.
Provider directories must be updated every 90 days. They need to be available on the carrier’s website and include the following details:
New protections say that if you relied on information from a provider directory that has been proven to be outdated when a more current directory was not available to you, the provider must limit their billing to in-network cost sharing.