Amplicare's Doctor Lookup tool helps you find provider network information while comparing Medicare Advantage and Special Needs plans. It's a great starting point to determine whether a patient can still see their preferred doctors on each plan. However, patients should always call providers ahead of appointments to verify that they are still in network with the plan in question. 

If a patient is attached to a specific doctor or doctors they’ve seen, provide them a list of at least three plan options with the provider(s) listed as in-network. Providing multiple options allows for some wiggle-room if a plan has outdated information on the network status of one or more of the patient's doctors. A patient can call their important providers and request network information for each plan in the same call, ensuring they are up-to-date on how their health services will be covered on each plan.

Why would my patient still need to call their provider to check network status?  

Our lookup tool is as reliable at the plan’s doctor network list. Online provider directories are designed to show patients which providers in their area are covered under their insurance plan, giving them more control over their care. The Medicare Advantage (MA) directory was specifically created in 2017 with the goal of empowering its enrollees with provider information.

However, key information is often missing or outdated, putting the patients who rely on this information in danger of denied care or unexpected medical bills. The CMS multi-year provider directory audit found that about 49% of provider entries on the MA directory had at least one mistake. Updates that needed to be made included phone numbers, addresses, and even the provider’s name. Not to mention, some providers were listed as taking new patients when they were not, and vice versa. 

In an effort to curb this confusion, CMS has introduced penalties and regulations that target errors in physician directories. While these rules will surely make some difference, it is still important for your patients to understand the shortcomings of provider directories and take the necessary precautions outlined above when considering a new plan. 

What's Next?

To learn more about the Doctor Lookup feature, click here!

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