Why directories are wrong so often
A 2018 federal review of Medicare Advantage directories found almost half of listed locations had at least one error. Doctors change groups, drop plans, and stop taking new patients faster than directories update. Since 2022 the No Surprises Act requires insurers to verify directory entries every 90 days and to honor in-network cost sharing if you relied on a wrong listing, which helps after the fact. It does not stop the wrong listing.
Plan versus insurer
"Do you take Aetna?" is the wrong question. Insurers sell dozens of plans with different networks: HMO, PPO, marketplace, Medicare Advantage, employer-specific. A doctor can be in one Aetna network and out of another. Read the plan name off your card and ask about that exact plan.
The four steps
- Start in your insurer's directory to build the list. It is the only source that knows your network at all.
- Call the office and ask: "Are you in network for [exact plan name], and is Dr. X accepting new patients on it?" Write down the date and the name of the person you spoke to.
- Call the insurer if anything is unclear and get a reference number for the call.
- At the visit, confirm again at check-in. Networks change between booking and visit.
Common traps
- The doctor is in network but the facility, lab, or anesthesiologist is not. Ask where labs and imaging go.
- Telehealth companies with clinicians in many states, only some of which are in your network.
- A directory listing for a group practice where only some clinicians take your plan.
- Out-of-network specialists your in-network doctor refers you to without checking.
Where this directory fits
Our listings show the insurance tags each clinician reports, which helps you build the shortlist, but only the office and your insurer can confirm your specific plan. Use us to find a clinician worth calling, then make the call.
Common questions
What if I relied on the directory and got billed out of network?
Under the No Surprises Act, if the insurer's directory said the doctor was in network when you booked, you can only be charged in-network cost sharing. Keep the screenshot and dispute the bill with your insurer.
Does 'accepts insurance' mean in network?
No. Many out-of-network practices will file a claim for you, which they call accepting insurance. In network means a contracted rate. Ask which.
