Tags: Healthcare Reform | california | exchange | misled | enrollees | doctors

California Obamacare Providers Investigated Over Provider Lists

Saturday, 21 Jun 2014 03:47 PM

By Sandy Fitzgerald


Officials at the California Department of Managed Health Care are investigating whether Anthem Blue Cross and Blue Shield of California misled patients looking for doctors who would accept their Obamacare policies.

"We began our review based on a pattern of complaints that came to our help center regarding provider access," agency spokeswoman Marta Green told the Los Angeles Times. "Our preliminary investigation gave us good cause to believe there are violations of the law."

Officials said they are looking at whether the companies misled potential customers by providing inaccurate provider lists, leaving patients still looking for physicians statewide.

Green said her department will likely finish its investigation within 60 days, after which the insurers will have another 45 days to respond.

The insurers acknowledged there have been some mistakes made about their provider networks, claiming they've contacted doctors to confirm the network status. Further, they say they've added more providers since January.

The president of Anthem Blue Cross has said the use of limited network provides for lower rates from medical providers, allowing it offer savings to customers.

Consumers have complained for months about smaller provider networks, and customers in California have had issues after insurers and the state's health exchange published erroneous provider lists.

In some cases, physicians' offices refused care, while in others, the insurer said the provider was out of network and would not cover their bills.

"Anthem and Blue Shield have led the pack on these network and provider issues," said Green.

Anthem received 115 provider-related complaints from January through June, while Blue Shield received 97 complaints.

But Anthem has said it will help customers find a doctor if they have trouble getting coverage.

"Anthem Blue Cross continually works to improve the accuracy of our provider directory," spokesman Darrel Ng said. Anthem has added more than 3,800 medical providers to its network since January.

And Blue Shield says 64 percent of physicians and more than 82 percent of the hospitals are included on the roster.

"We are redoubling our efforts to inform physicians and our customers as to what the network makeup is," said Steve Shivinsky, a Blue Shield spokesman. "If some corrective action is necessary as a result of the state survey, we will do that."

State officials hope to release the results of the investigation before open enrollment starts again in November.

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