Provider directory says in network. The doctor’s office says no. What should you do?

Three different problems get reported as one, and each one needs something different from you. The one that ends in a bill has a federal protection behind it.

By the Rollcall Health research team · 16 August 2026

You looked up a doctor in your health plan's directory. The listing said in network. You called, and the office told you something else. What you do next depends on which of three quite different problems you have run into.

Which problem you have

• The practice is not in network for your plan. It may hold a contract with your insurer and not for the plan on your card, because insurers sell several plans across several networks and a practice can take one and not another.
• The practice is in network and not taking new patients. The contract is real, the panel is closed, and your plan's directory is supposed to say so. That field goes stale quickly, because it changes without any contract changing.
• The clinician is not there any more. They have moved practice, retired, or their registration has been cancelled, and the listing still shows the old address.

Why this happens

Plans do check their directories. They collect files from practices, groups and intermediaries, run verification programmes and ask providers to confirm their details on a cycle. Those controls are real. They can still miss a change or lag behind it, because most of them look at the plan's own records rather than at anything outside, and a contract that ended in March can sit in the published file for a long time after.

Some of that is measurable. Across every provider directory published on the CMS federal Marketplace, the median listing that contradicted a dated federal record had been published for 327 days. That figure and the method behind it are in the 2026 Marketplace directory integrity report.

What to ask, and who to ask

1. Take the exact plan name and network name off your insurance card. "Do you take [insurer]?" is the question that produces wrong answers. "Are you participating in [network] for [plan]?" is the one worth asking.
2. Call your health plan, not only the office. Ask the plan to confirm that the clinician is participating in your specific plan and network as of today, and get the name of whoever tells you.
3. Ask your plan for that confirmation in writing: a secure message, an email, or a reference number for the call. It is the most useful thing to come away with.
4. Ask the office the same question. If the two answers disagree, the written one from your plan is what you keep.
5. Write down what each of them said and the date they said it.

If you were told wrong and then billed

The No Surprises Act can help where you relied on your plan's own network information and it turned out to be incorrect. If your plan's directory or a plan representative told you before the visit that the provider was in network, and that was wrong, your cost sharing for that visit can be capped at the in-network amount and counted toward your in-network deductible (42 U.S.C. 300gg-115(b)). It applies to care your plan already covers, limiting what you can be charged rather than adding cover your plan excludes. Whether it reaches your particular bill turns on the facts, which is why the dates and the written confirmation matter.

Where you have already paid more than the in-network amount, 42 U.S.C. 300gg-139(b) provides for the difference to come back to you with interest. The federal No Surprises Help Desk is on 1-800-985-3059, and there is a CMS complaint form.

What we can check, and what we cannot

We read what plans publish, from the outside. We can see what a directory said on a given date, and whether a listed registration has been cancelled or excluded in the federal record. That is a narrow set of facts, and every one of them carries a date.

What no federal file records is whether an office takes your plan today. Settling that takes contact with the practice, which is why what you were told is worth writing down.

That contact does not have to wait for a member to run into the problem. The records most likely to have gone stale can be picked out from the data first, then checked directly through email and voice outreach, with a person reviewing whatever does not resolve cleanly. We run that today, and we are building it to run continuously rather than as an occasional clean-up. How the verification ladder works

Tell us about it

If a directory listing did not hold up, tell us. We log every report against the directory files we have already read. One report is one person's bad afternoon. Together they show which listings and which plans keep coming up, and a recurring pattern is much harder to put down to bad luck than a single call.

Useful to include: your plan's name and state, where you found the listing, what you were told, and the date. Please do not send medical details. We never publish a clinician's name, and we never publish yours.