Photo of Senator Kennedy.

State Senator

Ted Kennedy, Jr.

Representing Branford, Durham, Guilford, Killingworth, Madison & North Branford

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Kennedy: New Provider Directory Law Will Ensure Fair and Transparent Access to Care

New consumer protection law will require greater accuracy and transparency in health plan provider directories

Senator Ted Kennedy, Jr. introduced and led successful General Assembly passage of an important improvement to health insurance law by requiring health insurance companies to disclose and clarify which of their participating providers listed in their provider directories are actually available for an appointment on an outpatient basis. Senate Bill 546, now Public Act 17-154, passed both chambers and awaits final action by Governor Malloy.

“Many patients from my district and from across Connecticut voiced a common concern about the list of doctors in their health plans: that many of the doctors, were not, in fact, offering any appointments. Many of these participating provider lists are therefore inaccurate and misleading,” said Senator Kennedy, Vice Chair of the Public Health Committee and a healthcare attorney. “Consumers rely on the accuracy of health insurance provider lists when shopping for a health plan or when they are facing an urgent health care crisis. They do not have the time to call through an endless list of doctors, only to be told that the doctor does not have any open appointments. This bill will help patients make an appointment with a doctor in their plan much more quickly.”

Current law requires that health insurance companies maintain a current provider directory on their websites and update that directory monthly. However, consumers are still confused and misled in an important respect: many medical disciplines, such as cardiology, intensive care and psychiatry, have certain doctors who only practice in a hospital and do not see patients for office visits and outpatient consultations and treatment. The listing of these doctors in a provider directory is accurate insofar as they are technically in the plan’s network. However, without the important distinction and clarification that these doctors are hospital inpatient-only providers, the network is misleading because these hospital-based doctors are not available for typical appointments. Listing inpatient-only providers without properly identifying them creates a false impression that there are many more doctors available to treat a patient than there really are. Kennedy’s new law changes that.

“What we support is that insurers keep an accurate and up to date record of active providers and don’t shift this burden on the consumers or families in crisis,” said Mirella Loftus of the CT Council on Child and Adolescent Psychiatry when testifying in support of SB 546 earlier this year. “The insurers must keep these lists up-to-date frequently and they must be accurate. Once a year or less is not enough.”

“The measures proposed in Senate Bill 546 would help ensure accurate provider directories and timely access to care. Numerous studies have shown that early interventions and consistent outpatient treatment reduce hospital recidivism rates. On a regular basis I see patients in the hospital who give up after calling numerous providers as they were unable to schedule a single appointment. For these reasons the Yale Psychiatry Advocacy Alliance urges you to support the amendments proposed in Senate Bill 546,” said Dr. Walter Piddoubny, a physician and psychiatry fellow in psychosomatic medicine and a member of the Yale Psychiatry Advocacy Alliance at the Yale Department of Psychiatry, when testifying in support of SB 546 earlier this year.

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