The Hidden Data Errors Delay Healthcare for Millions of Americans

You’ve never heard that because it has never been said. Even in places like Boston and Washington/Baltimore, regarded as academic and innovation hubs known for their life sciences and pharmaceutical breakthroughs, healthcare innovation, and cutting-edge research, this is a reality. Despite being surrounded by the best healthcare institutions in the country, if not the world, if people in those regions cannot easily find reliable healthcare covered by their own insurance, that reveals a much bigger, more alarming concern in our healthcare system. 

What’s creating the divide between providers and the reality of the difficulty in finding quality, affordable care? At its core, it’s an access crisis, impacting millions of Americans. It’s not just an isolated problem for a few patients; it is a nationwide issue.

Recent data from the Commonwealth Fund shows one-quarter of Americans are underinsured – a problem that’s soon to compound as recent estimates forecast up to 12 million Americans losing health insurance coverage in the next decade. 

Before this grim future sets in, access issues persist at present – even for those with health insurance. Simply put, being insured no longer means having access to quality, timely healthcare. 57% of underinsured adults reported avoiding getting needed health care due to high costs. These cost increases often occur if a provider is out of network, leading patients to not visit a doctor when sick, skip a follow-up visit or test, not see a specialist, or not fill a prescription. 

Anxiety about incurring expenses for unaffordable, often out-of-network care is endangering the health of insured Americans. 41% of adults who reported they delayed or skipped getting necessary care because of costs reported a health problem had gotten worse as a result, showing the cost and access crisis has serious consequences.

The care is there, but the crux of the problem that creates access issues for insured Americans is  provider data is not always updated and is hard to find. This causes people to put off care,  ultimately leading to poorer patient outcomes and more expensive care. We know cost is an ongoing issue in American healthcare, and research from KFF confirms this. Just under half of U.S. adults (44%) say that it is very or somewhat difficult for them to afford their health care costs, regardless if that care is in-network or out. 

These numbers reveal a harsher reality: With inflation and rising costs of everything from housing to everyday essentials, healthcare has become another basic need that many Americans will have to forgo due to costs. 

While no one claims to have the solution to ensure all Americans have access to high-quality healthcare, we do know what’s contributing to the problem. Provider directories are often outdated, which leads to scheduling conflicts, surprise costs for out-of-network services, and overall frustration. 

The cost of poor data quality and network inaccuracy

Now that we’ve identified how it impacts patients, provider network accuracy is no longer just an administrative checkbox; it’s a public health issue. If patients can’t quickly and easily identify in-network providers, they delay care, skip preventative – and potentially life-saving – screenings, or pay out of pocket, all of which deepen health inequities and negatively impact health outcomes. 

There’s also a massive financial toll on the entire healthcare system. Poor data quality costs U.S. companies $3.1 trillion annually. Quality provider data keeps the U.S. healthcare system paid and operating. Every health insurance plan maintains a directory of provider data, including listings of healthcare professionals and facilities that are part of that insurance plan’s network. It’s a critical resource that ensures patients can find and select healthcare providers within their insurance network to receive care covered by their health plans. 

However, a recent industry study revealed four out of five provider directory entries in the five largest private health plans were inaccurate. The incorrect data in these directories costs payers millions in lost revenue and regulatory penalties. That cost is passed along to the American public and further compounds skyrocketing healthcare expenses. 

A better path forward 

To tackle this public health issue, we must first look at data like other critical hospital infrastructure. This means modernizing directory standards. With today’s technology, accuracy must be verified quickly and easily. This means payers, providers, and technology companies must collaborate and share the responsibility. Directory updates should be treated as mission-critical work for better patient care, not busy admin work. We should all be better stewards of data and collaborate on innovation. 

From a policy and regulatory perspective, provider data accuracy should be a national health equity focus. Regulatory enforcement has been inconsistent, leaving little motivation for some of the biggest players to comply.

We need transparency. Patients deserve clear, updated, and easily searchable provider information. In 2025, it’s completely unacceptable that a barrier to care is something as basic as not being able to find a correct phone number to make an appointment. If we can’t ensure patients can even reach a provider, we have little hope of addressing the larger crisis of healthcare access and inequity Americans confront today.

Image: Erhui1979, Getty Images

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