REAL Health Providers Act

The REAL Health Providers Act would establish new requirements for Medicare Advantage insurance plans to keep their provider directories accurate and up-to-date. The bill addresses a widespread problem known as "ghost networks," where providers listed in directories are no longer practicing, not accepting new patients, or not actually in-network with the plan. This can force patients to experience delays, denials, or unexpected medical bills. The legislation would require Medicare Advantage plans to verify provider information at least every 90 days, remove providers from directories within five business days of learning they are no longer in-network, and clearly mark any provider information that cannot be verified as potentially outdated. If a patient sees a provider listed in the directory who turns out not to be in-network, the patient would only pay the cost-sharing amount they would owe if the provider were in-network, protecting them from surprise bills. Starting in 2029, plans would be required to publicly display their provider directory accuracy scores so patients can compare plan quality. The bill would also require Medicare Advantage organizations to conduct annual analyses of their directory accuracy and submit reports to the federal government, with particular attention to specialties like mental health and substance use disorder treatment that have historically had higher inaccuracy rates.