Improving Provider Directory Accessibility at Scale

Man looking about Section 508 Compliance on his computer in an office

Equidox collaborates with insurance organizations to ensure the provider directories they provide as PDFs to their customers are legally compliant with the ADA, Section 508, and other accessibility laws. 

In our industry research, we have found that most provider directories were inaccessible to people with disabilities and therefore not legally compliant. Over 50% of provider directories had no tags for accessibility, and even those with tags contained errors rendering the document unusable for someone who uses assistive technology to read PDFs.

Making these large PDFs accessible is difficult, but understanding the most challenging issues and finding an efficient solution can make compliance achievable.

Applicable laws

Current laws such as the Americans with Disabilities Act, the Affordable Care Act, and Section 508 of the Rehabilitation Act mandate that customer communications for healthcare companies be accessible to people with disabilities.  All online communications, including PDF documents, need to function with assistive technology, which helps people with disabilities access digital information. Many state-specific laws also apply to customer communications. This means organizations must ensure provider directory accessibility for PDFs as well. To make these PDFs accessible, tags must be added to each element of the document, allowing assistive technology to tell the user what information is on the page and navigate it easily.

Challenges of remediating enormous PDFs

Insurance companies compile numerous physician or provider directories across multiple plans and regions, that are provided in multiple languages. The sheer volume and complexity of these directories, often spanning thousands of pages, pose a formidable challenge in remediating them to meet accessibility standards.  While some organizations handle remediation in-house, many opt for outsourcing, which introduces the risk of inaccessible content if proper accessibility testing is not conducted.

Additionally, the cost of staff time or financial outlay for outsourcing can be considerable when addressing thousands of PDF pages. Organizations must also take into account human error. To ensure remediation is done correctly, the remediated PDFs must also be checked and validated. Automated testing alone cannot determine whether or not remediated documents are accessible. Manual checks for heading structure, reading order, alt text, and overall usability are necessary. 

Avoid Common errors

The most common errors in provider directories are flawed heading structure, incorrect reading order, and lack of alternative text (alt-text) on images. While these may seem minor, they significantly impact the usability of these directories for individuals with disabilities. Notably, automated checkers often fail to detect these issues, necessitating manual checks with assistive technologies like screen readers. 

Heading structure

Headings make a document navigable so the user can find specific content. 

Why it matters 

A lack of proper heading structure can make it difficult or impossible for users to locate specific information, such as differentiating dermatologists or cardiologists among thousands of other physicians. It could take hours to tab through the content of a 1500-page directory to find the correct entry. 

Reading order

Another common issue among tagged documents is reading order. In tagged documents, visual appearance may not accurately reflect the digital reading order.  This often isn’t observable to a sighted person, only someone using assistive technology. 

Why it matters

Discrepancies in reading order can lead to inaccuracies in finding essential information, such as contact details for a specific doctor. Most physician directories are arranged in a multi-column format.  This means that without the correct reading order, someone using assistive technology might get content from line one of EACH column reading from left to right across the page, rather than reading down each column and then continuing to the next one. That will not provide accurate information to help a patient find the right doctor. 

Incorrect reading order can also result in content not being read together that belongs together. If all content is not in exactly the correct order, wrong phone numbers or addresses may be read along with the wrong doctors. 

Alt-text for Images

Many directories we audited contained untagged images. 

Why it matters

When images are untagged, rather than explaining what the image portrays, the assistive technology announces “IMAGE” without providing context. This is particularly problematic when directories contain icons conveying crucial information, such as proximity to public transportation or the availability of physical accessibility features such as elevators or Braille signage. The absence of alt text deprives users of valuable information vital to their decision-making process. 

Achieving accessibility at scale

Many insurance companies face these common accessibility problems in their provider directory PDFs because manually, accurately tagging each of these elements is simply impractical at scale. The best solution is to automate the task of PDF accessibility to eliminate manual errors, complete the task quickly, and stay on budget. 

To streamline the process of ensuring accessibility compliance, Equidox offers an automated solution, Equidox AI. This custom-trained solution efficiently remediates physician directories, ensuring proper heading tags, alt text for images, and reading order in your unique documents. PDFs remediated by Equidox AI not only pass automated checkers but also pass manual checks with screen readers, guaranteeing legal compliance and accessibility for all users.

Are your provider directories accessible?

Ensuring accessibility is not just a legal requirement; it’s a commitment to inclusivity. If you’re uncertain about the accessibility of your physician directories, we can help with a complimentary provider directory accessibility audit. Discover how Equidox AI can simplify the process, providing accessible content for all your customers. Contact us for your free consultation.


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Tammy Albee

Tammy Albee | Director of Marketing | Equidox Tammy joined Equidox after four years of experience working at the National Federation of the Blind. She firmly maintains that accessibility is about reaching everyone, regardless of ability, and boosting your market share in the process. "Nobody should be barred from accessing information. It's what drives our modern society."