In an effort to address a pressing concern of employees when choosing a health plan — is their doctor in the insurer’s roster of medical professionals? — health data service firm Vericred has created a service that will allow benefit advisers and administrators to inform clients when a doctor joins or leaves a provider network.

Bloomberg/file photo

Set to debut this summer, the Provider Network Notification will identify changes in its provider-network data and send notifications via webhooks to its insurance broker and benefit administration clients any time a doctor or medical facility joins or leaves a network. The brokers and benefit providers can then use the updated information to notify employees about the change via email, text message or a mailed letter.

Proactive information
This notification service aims to reduce the unexpected bills and administrative burden that result from unintended use of out-of-network providers, according to Vericred.

“What happens when a doctor moves out of network? We wanted to help advisers and admins use this to help eliminate the circumstance when a parent has a sick child and doesn’t know if their pediatrician is currently in a network,” says Michael W. Levin, CEO of Vericred. “Do you pay out of network, find a new doctor or go to an ER?”

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Benefit advisers can take the Provider Network Notification data and create tools and apps that will deliver weekly or monthly updates of provider status instead of the annual or quarterly updates that are the current norm.

“We have created the infrastructure where admins and brokers can send the information out proactively,” says Levin, who estimates that 5% to 8% of doctors leave a network each month.

The solution is aimed at health insurers, HR and benefit administration system providers, private and public exchanges, and health and wellness app designers. Levin predicts that end-user apps will be available in the fall.

“We don’t want it to be a once a year destination. This is a functionality designed for benefit advisers to help their clients,” says Levin. “In two or three years, we hope this will be ubiquitous and that someone will never be surprised by their doctor being out of a network again.”

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