Errors mar doctors’ list on exchange

I have regularly sent information to my clients about the problems with provider finders which are critical in the Health Care Reform decision making process.

Below is an article from the Los Angeles Times dated October 17, 2013 which discusses this issue.

Covered California apologizes as consumers are left in dark over providers.


Checking up on a doctor is becoming a major snag for Obamacare shoppers in California.

Three weeks into open enrollment, the state’s insurance exchange, Covered California, has pulled its online directory of medical providers after acknowledging there are serious problems with the information. The California Medical Assn. says it found mistakes such as obstetricians labeled as ophthalmologists and the wrong doctors described as fluent in Russian and Farsi.

Anthem Blue Cross, the state’s largest for-profit health insurer, has shut down a similar physician search tool on its website until it can be updated for new plans for sale now under the federal healthcare law. And consumers say calling other insurers and doctor’s offices around the state often yields confusing or conflicting answers, leaving them largely in the dark.

“Nobody can give me a straight answer,” said Larry Greenfield, a 47-year-old musician in Fountain Valley. He said he has checked online and called insurers to no avail as he tries to choose between different exchange policies. “I don’t want to be forced to buy something if I don’t know what I’m getting.”

Overall, Covered California’s website and enrollment system appear to have recovered from some early computer glitches to post a solid start for sign-ups. The insurance exchange announced this week that nearly 95,000 applications for health coverage have been started since Oct.1. Officials won’t disclose how many applications have ac- tually been completed.

Some consumers may be holding off until more details are available on what doctors and hospitals are included in the health plan networks. That could put a damper on enrollment for the time being.

This information is particularly important because many insurers reduced their provider networks in the exchange in an effort to hold down rates. Blue Shield of California says it will include about half of its contracted doctors. In contrast, HMO giant Kaiser Permanente is making its full network of doctors available.

For months, Covered California has promised a convenient online search tool to help people find their preferred medical providers. But it wasn’t available when enrollment launched Oct. 1, and it’s been offline since Oct. 9 while fixes are being made. An exchange spokesman said it might be restored sometime in the next week.

“We knew this would be a heavy lift,” said exchange spokesman Larry Hicks. “We do apologize for the inconsistency in the provider tool and we appreciate consumers’ patience.”

Some insurers directly asked doctors whether they wanted to sign new contracts for treating exchange patients. In other instances, it’s been less clear. Under state law, insurance companies can also add doctors who are currently in their network to other products such as those in Covered California. The insurers must merely send a notice giving physicians the opportunity to opt out.

“Some doctors are listed as exchange providers when they are not aware of ever signing up, which was one of the fears we had,” said Dr. Richard Thorp, a general internist and president of the California Medical Assn., which represents about 37,000 doctors. “It’s important for this information to be accurate so consumers can have faith in it.”

Many people don’t want to lose a long-standing relationship with a family doctor or well-regarded specialist. Others express concern about having to pay more out of pocket if providers they want to see regularly are outside the network.

Greenfield, a professional violinist, is set to lose his Kaiser insurance through a musicians’ union at year-end.

He researched his options at Covered California and liked a plan from Anthem Blue Cross that costs $267 a month starting in January.

But he couldn’t find any information online about what doctors are included, and the company’s customer-service center couldn’t help him either.

Then he turned to a Gold-level plan from Health Net Inc. for $356 a month. The company’s website listed one of his doctors as being in the network, but the hospital that she’s affiliated with was excluded.

Greenfield called Health Net’s service center to reconcile that but couldn’t get a definitive answer.

A Health Net spokesman said its online search tool reflects the new exchange plans and the company urges consumers to call for more information.

Anthem said its physician database should be back up shortly.

Jef Kurfess of Westlake Village has been shopping for health plans on Covered California for his two adult sons and possibly for his wife. He says he hit many of the same roadblocks while searching for local doctors and a nearby hospital.

“Getting an incredibly inexpensive plan with no doctors you want to see will be a rude shock for people,” Kurfess said. “I can’t proceed to make a knowledgeable selection.”   Twitter: @chadterhune


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