Making A Reality

Ok, that website really isn’t a project, but a website that has that functionality would be awesome. I recently had this problem. I was getting new health insurance and I wanted to know if our regular doctors would be part of the new insurance plan’s network. What a pain in the butt. Even the health insurance companies website made it difficult to know if they accepted the plan. The networks were named different than the insurance. Just plain ugly!

Turns out that Fred Trotter is doing what he can to help solve the “out of network” insurance game. Since it’s Fred Trotter you know it’s based on freeing the data. The post is well worth a read, but highlights why figuring out if your going to an in network or out of network provider is important and how the insurance companies are making it difficult to get access to this data.

Fred also points out a possible solution to a problem found in the text of the Notice of Benefit and Payment Parameters for 2016 (don’t you love how quickly the government works?). This new rule would essentially require insurance companies to provide an updated directory of providers and possibly requiring that they provide it in a machine-readable format. Seems like a small thing, but it would make a big difference.

However, this is the money quote from Fred about the government proposal above:

This would solve the problem. Anyone who wanted to could create a website that showed what plans any given provider accepted, would be able to easily do so.

But they key word here is “propose”. Insurance companies in this country benefit greatly from the confusion about in network and out of network, and so do some unethical healthcare providers. There will be lots of people who oppose this proposal.

I hope that I have made the case that this information needs to be open and machine readable. If your convinced, then you can find the comment page to support this policy here. If you disagree with us, and you still want to submit a comment, you can use this page.

Comments on this rule are due by 12/22 which doesn’t leave people much time to chime in. As someone who’s had to deal with this challenge recently, I hope that this rule is passed. I can’t wait for an entrepreneur to take this data and create a beautiful map overlay of the doctors in my network. Would make searching for a doctor in your insurance plan so much easier.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.