Covered Calif. Removes Provider Directory To Fix Inaccuracies

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TOPIC ALERT:

Last week, Covered California removed a consolidated directory of doctors and hospitals from the exchange website because some providers were falsely listed as accepting insurance plans that were not a part of their network, AP/Modern Healthcare reports (AP/Modern Healthcare, 2/9).

Background

The directory of health care providers associated with exchange plans originally was scheduled to be available during the first week of open enrollment -- which began Oct. 1, 2013 -- but it was delayed and did not go online until a week later.

The physician directory then was taken offline later that month because of:

  • Inaccuracies; and
  • Slow loading times.

In addition, some consumers had reported problems identifying which plans would be serviced by popular provider groups (California Healthline, 10/11/13).

Covered California published an updated directory in November 2013.

Details of Latest Removal

Some consumers who purchased coverage that took effect Jan. 1 said that certain physicians would not accept their insurance even though they were listed as part of their network on the exchange website, according to the Los Angeles Times' "Money & Co." (Terhune, "Money & Co.," Los Angeles Times, 2/7).

In a statement, Covered California spokesperson Anne Gonzales said, "While many people were having success with it, some were not," adding, "We decided that all of the plans needed to submit accurate data to us in order for it to work correctly" (Sisson, U-T San Diego, 2/7).

State officials noted that consumers still can switch plans before the first wave of open enrollment ends on March 31.

In the meantime, the exchange website will provide consumers with links to each health insurance plan's physician directory (Robertson, Sacramento Business Journal, 2/7).

Exchange officials said they do not have a "firm date" for reinstating the physician directory.

Reaction

In a statement, the California Medical Association said, "The state's exchange has done the right thing in trying to address the inadequacies and misinformation and, to that end, CMA will be as helpful as possible, but it is up to Covered California to get the provider directories promptly in order so that Californians can evaluate what kind of access each exchange plan offers" (O'Neill, "KPCC News," KPCC, 2/7).

Anthony Wright, executive director of Health Access California, said, "[I]t's especially important now that people have the ability to change plans ... to know what other plans their doctors are in." He added, "This is something we need to get a handle on quickly" (Sacramento Business Journal, 2/7).

Kevin Knauss
Changing plans also has it's own perils. If not done correctly, Covered California is terminating participation in the first plan retroactively causing formers to be on the hook for medical expenses they have already incurred. Proceed cautiously when terminating the current plan to switch to a new plan with the correct physicians.
Joey Torcellini
Not that it will help, but about 2 weeks ago I filed a complaint with the Dept of Insurance regarding Anthem's inaccurate Find A Doctor In-network data. My complaint was forwarded to the Department of Managed Health Care. The DMHC called me today to confirm it was OK for the DMHC to use my name in the complaint that will be sent to Anthem. I agreed, and also faxed them some proof that one of my doctors was showing In-network on Anthem's website until about Jan 22, 2014, at which time he was removed. My complaint really stemmed from an email response from Anthem which stated that the accuracy of Anthem's In-network information was the responsibility of the doctor/provider, not Anthem. Anthem told me to call the doctor if there was a question. What a crock. Since I am paying Anthem for insurance, they should be responsible for providing me with accurate "product" information. Their lackadaisical attitude got me going on my complaint.
Jonathan Savell
Originally Blue Shield was going to have 3 different networks depending on the payment rates, but only the largest network would be displayed. So a silver member would be ineligible to see a platinum provider. Too much emphasis was placed on low price and narrow networks instead of aiming for quality.
Carol Frandsen
This just so angers and sickens me. Many of us insuring ourselves for years and then canceled and treated like this. What can we do? Its just seems NO ONE is even listening or cares anymore. I have written and called and complained for myself and in support of others. Heck, after almost 5 months, CCA website still doe not even work!! Its a disgrace. Lynda's story of driving around to find a doctor is UNACCEPTABLE. Is anyone of authority even listening?? I feel for and send thoughts to everyone.
lynda spencer
You are exactly correct Joey!! The BC site is incorrect also, every doctor I wanted I called and they said NO not in your plan. In Jan. I spent 3 days in my car visiting my doctors offices, and many offices I have never been to trying to find out who will take my insurance, most will not and my current doctors will not take me any longer. I finally got someone to explain why and its the reimbursement rate, plain and simple. I may have found the group that will take me with only 2 doctors accepting new pat. but even they cant tell me for sure, and of course I cant reach anyone from BC on the phone. Ive never felt discriminated against when going to the doctors but I have now, as soon as they find out I've purchase my insurance from Cov. CA. the EXCHANGE or OBAMA CARE they ask, they don't want anything to do with me. Just telling it like it is.

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