In-network and out-of-network
A provider is in-network when they have a contract with a health plan to see its members at agreed rates, and out-of-network when they don't. Network status decides what the member pays, so a wrong status in the directory can cost the member money.
Why does network status matter to members?
In-network care usually costs members much less. Out-of-network care can cost more, or not be covered at all, depending on the plan.
How can network status be wrong in a directory?
A provider leaves a contract, joins a different group that isn't contracted, or participates in some of a plan's products but not others. If the directory isn't updated, members are told the provider is in-network when they aren't.
What protects members?
Under the No Surprises Act, if a member relies on a directory that wrongly lists a provider as in-network, the plan generally can't charge more than in-network cost-sharing for that visit.