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Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Will My Doctors Accept Covered California Patients?

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Question: I am concerned that few private doctors will accept the California Exchange insurance and I will have to go to clinics that only the poorer people without insurance use.

Answer: You should not be concerned. Covered California is a marketplace that offers coverage underwritten by private insurance companies. Providers - doctors, hospitals, etc. - will continue to be contracted with the insurance companies, not directly with Covered California. For example, if a doctor is now part of Blue Shield’s network, in all probability they will continue in Shield’s network within the exchange.

33 Comments

I know this reply is way after your original post, but Anthem Blue Cross is the most terrible insurance company out there, according to my own doctor. Maybe you should select a different company through Covered CA.

Jill, glad you’re happy with Kaiser but the same could be said for anyone who is willing to give up their existing doctors (more or less) and see doctors within a narrower provider network on one of the other ACA health plans.

If you aren’t wed to specific doctors, consider enrolling in the Kaiser Permanente plan through Covered California. We enrolled in January and have not had any problem getting care from family doctors and specialists within the Kaiser network. Yes, it was frustrating to give up our existing doctors and start over with new ones. ( we are still paying out of pocket for one specialist outside the Kaiser system.) But we certainly have not had any problem getting care from qualified doctors under Covered California and have avoided the hassle and frustration of having to find doctors ourselves who will take our insurance.

DOCTORS ARE DROPPING THE COVERED CALIFORNIA PLANS DESPITE THE FACT THAT WE ARE PAYING THE SAME PREMIUMS FOR THE SAME PLANS OFFERED DIRECTLY BY THE INSURANCE COMPANIES. WHY? BECAUSE THE INSURANCE COMPANIES ARE REIMBURSING DOCTORS AT A LOWER RATE FOR THE SAME PLANS IF THE PLAN IS UNDER COVERED CALIFORNIA. THIS SHOULD NOT BE LEGAL!!!

I HAVE HAD NOTHING BUT THE RUN AROUND TO GET CARE BEFORE THIS I NEVER REALLY NEEDED ALOT OF CARE NOW I NEED IT THE WORST AND THERE IS NO HELP EVEN AT THE DR.S OFFICE THANKS OBAMA AND WHO EVER ELSE IS THE PROBLEM…………….

I had visited my doctor a couple of weeks ago…She ordered labs and a cardio monitor, etc…The day before my appointment to get the results of those tests, I received a call from her office that “Covered California just wasn’t working out for them”…so, just to let me know they stopped taking it two weeks prior. Now I pay a full premium…No subsidy, and my doctor won’t see me and I can’t find out what the labs and tests revealed. PLEASE AMERICA…WAKE UP! EVERYTHING THAT COULD GO WRONG WITH THIS PROGRAM HAS GONE WRONG. I was self-insured before…perfectly fine policy…Now, I pay more than twice the premium and no one will take me. WHY ARE WE ALLOWING THIS TO HAPPEN TO US? THIS IS PURE EVIL.

My insurance was cancelled last year and I was told by Blur Cross that I HAD to go to Covered California because they were no longer writing individual coverage. I was told by Covered California and by Blue Shield (which was the only company writing PPOs that the Covered CA PPO was a straight Blue Shield PPO. Since the database through Covered CA was not to be trusted, I called each of my doctors directly and was told that they took Blue Shield PPO. I called in December, but the first appointment in February was met with “we don’t take Covered California”. I have recently learned that although I am expected to commit to a yearly contract, Blue Shield changed its rules for doctors. They are contracted monthly, so in December 2013, the doctors were contracted, but in February the doctors had cancelled their contracts. This is a “bait and switch” scam! I am now fighting with the Department of Managed Care to get this resolved…and guess what? I cannot get my emails or calls returned. This is a badly written law and no one is trying to fix it. I do vote, and Democrats are now dead to me.

I am a consumer who has BS CoveredCA and have 18 years in the medical billing field. I was hopeful that these plans would come through like they said they would and provide healthcare at a “reasonable cost”. I am VERY CONCERNED with the access to care and the reimbursement rates from BX and BS Covered CA plans. There are not many providers/specialists that accept this insurance in our area (San Luis Obispo county). The reimbursement for these policies really needs to be reconsidered. Provider reimbursement needs to be acceptable so that providers, facilities and specialists can be contracted providers and provide necessary medical care to patients with this coverage. These are serious issues that need to be known and addressed. The fact that patients are NOT ABLE TO KEEP THEIR SAME PROVIDERS, which is vital for quality and consistent healthcare is a major concern. I have read concerning posts stating that patients were not able access care locally or have to pay cash to specialists.If the health plans pay acceptable rates (or at least close to it) then providers will be willing and able to see patients with this insurance. Please find a solution.

I asked my dr about the covered ca plan that she takes(blue shield) she said the only problem is that her patients that have it can’t find specialist doctors in the east bay that will accept it. My pulmonary dr won’t & another patient who needed an orthopedic surgeon couldn’t find anyone from Oakland down past San Jose that would accept it.

I guess I’m screwed once my cobra ends if I need a non family doctor. Will they be fixing this before 2015?

I work for a Physician office and I can tell you the Physicians that take Covered California are loosing lots of money. Some of the plans available have a plan deductible, which most can not meet, plus they are paying for the coverage, our office was paid $1.63 for a visit and the patient had a deductible of $9000.00, I received a hardship letter from the patient asking to waive the remaining bill. What is one to do in such a case, we can’t always waive the remainder, we would not be in business, reimbursement rates are at a all time low now and many services have been cut from plans, its already difficult to have a practice and then provide good care, I feel the insurances companies should be held accountable for all issues. Hope this ends soon. Good luck to all out there seeking care under Covered California, don’t blame the Providers, blame the insurance companies.

Yep, glad to know there are others That share my frustration. In addition to all that (paying premiums AND Cash for dr visits) My children were taken off the plan and given To medi Cal which has taken 8 months to go through But my premium automatically includes a pediatric “fee”

I have Blue Cross insurance through Covered California and I have called a lot of the family practice doctors in my area and they will not accept Blue Cross through Covered CA. The Doctors offices refer me to a low cost clinic. What am I suppose to do? I have developed some health issues and I can’t find a Doctor that I can go to. I don’t have much confidence in the low cost clinics.

I have to say that it is almost impossible to find a Doctor who is excepting Covered California. Doctors are telling me that the Insurance companies are not paying them and that the requirements and new regulations are too expensive.

I personally witnessed a member of Anthem’s CoveredCa get turned away by a Doctor’s front office staff because she presented her affordable care act insurance card. It felt like she was being berated because she had Covered Ca.

This needs to be addressed immediately if not sooner. My daughter in SF was being seen by Medical One care, then they dropped her when she changed over to Covered Ca.. I am on the front lines of this issue not just someone eating popcorn on the sidelines and guessing at what is going on. Another scam being pulled on ACA members is that insurance companies are billing quarterly in advance. That’s one way of making more money off of the people that can’t afford it.

My daughter enrolled in covered ca. How can we get a list of doctors in Yuba, Sutter or Butte county that will accept her plan thru Blue Shield

I am finding there are not any doctors who will take my covered ca blue shield ppo. THIS IS A DISASTER. I cannot get through to Blue Shield on their phone line, and the website does not have any useful info. Something’s gotta give.

Just want to state we are having the same problem as everyone else. None of our current providers of ( 20 years) accept Blue Cross Covered Ca plans. The funny thing is we are being told by BC that our plan is not a CCP and they still will not accept it.

Plus , it’s almost impossible to get anyone on the phone from BC to even talk to. Hour and hours on hold. HELP HELP PLEASE !!!!

Michelle, Thanks for your comment. I believe your comment is the first that sheds light on the provider side of this mess. Based on what you’ve said, it appears to me that you never should have been listed in the Blue Cross Covered California (Pathways X) network and once Anthem realized that they removed you. I’m still in the dark about the process the carriers used to opt-in providers for their 2014 individual plan networks initially and on and ongoing basis.

Yes, the initial answer is dead wrong—I am a physician and Blue Cross Covered CA pulled a bait and switch on our patients, they said we were covered provider (never saw a request/letter/contract/anything) but abruptly ended their association with my 2 physician practice on 3/31 with NO NOTIFICATION, now my patients are stuck with insurance that will not cover them in my office, I’m a pediatrician and baby vaccines cost about $400 for me to purchase, I can’t give them for free and my families can’t afford to pay that. I still believe in the ACA, its the insurance companies that are PROFITING at the expense of everyone

The initial response is incorrect. As a consumer, you should be very concerned. I signed up for the program last fall, and chose the highest Anthem Blue Cross program available. I started making automatic payments January 1. Anthem Blue Cross and Anthem Blue Cross through Covered CA are NOT the same programs. My ophthalmologist, GP, and cardiologist take private pay Blue Cross —- but will not take Blue Cross through CoveredCA. Physicians were sent letters last year explaining that if they did not respond to the contrary, they would automatically be placed on the provider list. My ophthalmologist said he never saw the letter — and had to call in February to me removed. My cardiologist is on the list —- but he will not accept the insurance (and as an independent contractor, does not have to)…..I have received a list of specialists in a 75 mile radius of my home. I have yet to find one doctor that will accept payment thru Blue Cross/CoveredCA…..So, I’ve now made 4 months of payments and I’m continuing to make 100% “out-of-pocket” costs for services…YES, everyone can get insurance —— but that doesn’t mean we can get a doctor! This realization has overwhelmed me! (and I’ve heard that doctors have been asked to take only 30% of their costs thru the CC program!)

I am in San Luis Obispo. My GP is most certainly not accepting my Anthem Blue Cross Bronze PPO with “Covered California” stamped on the card. They are not taking Covered California plans through Anthem BC, even though Anthem BC lists them as a provider and swears they are a provider. The doctor’s office said they opted out of Covered California plans since Anthem BC is only paying at rates less than medicare. They will not see me unless I pay cash.

Additionally, I needed to see a (non-pediatric) gastroenterologist and there are none in my town taking Covered CA. Had to travel 35 miles to Santa Maria for the closest one. I believe the law is that there needs to be one specialist for every 2,000 people within 15 miles.

i am having the same problem. enrolled in the blue cross ppo through covered ca program, but having a hard time finding any doctor that accepts this insurance. i’ve been paying as a cash patient and hoping the doctors office will accept this insurance so i can get reimbursement from the insurance company. so far, looks like none of the doctor i called accepts covered ca. and i am still paying for the premium every month, and cash on my own! what a scam! thinking to change my insurance. Doctors, please get contracted with covered ca program so we can use our insurance!

Linda, You have proved the point that calling doctors is futile. Blue Shield lists 400 doctors within 5 miles of Fresno in their 2014 Individual PPO Covered California network. Use the Blue Shield online provider finder at https://www.blueshieldca.com/fap/app/search.html then select your plan “2014 Individual Family Plan (including Covered California)” then select sub-plan (Silver, Bronze etc) then “Set Plan” and enter your city. Voila!

I have called every doctor in the phone book here in Fresno,and not 1 is accepting BLUE SHIELDS OF CALIFORNIA not offered through an employer.If it is through the state of Califnia,it is not accepted.Can I get my premiums refunded? This is frustrating.

Is there a list of doctors that accept covered CA in 92026 Anthem Blue Cross EPO

Is there a list of doctors accepting covered california plans in my zip code 95355? If so how do i get one.

Thank You

How can I get a list of doctors and hospitals that are under Covered California in the Los Angeles area?

I am concerned about retaining my doctors and hospital. I have a private policy which will expire on December 31st. Where can I find a list of doctors and hospitals in are that are or will be contracted with each of the plans the coveredca marketplace offers.

It will be extremely difficult to make an informed decision without this information.

As a physician in Riverside who has not been contacted by any insurance company offering Covered California, I would not suggest that patients or insurance companies assume I will accept this insurance.

I am very concerned that few doctors and medical groups will accept Covered California Insurance. I contacted my current doctor (which I pay out of pocket) and was told that none of the doctors in Riverside Medical Group will accept this insurance. I don’t see a list on the Covered California Website addressing this at all — if your current doctor does not accept it, where am I supposed to go to figure out who will accept this? I’ve had my current doctor for almost a decade.

Please define “soon” since the provider directories are a material factor in this sad little game.

The insurers will make their provider directories available soon.

how can I get list of doctors signed up in San Luis Obispo County

You told someone not to be concerned regarding physician participation. But Blue Cross is only enrolling physicians already in a very select network with few participants, and Blue Shield is asking physicians if they will accept 70% of Blue Shield usual rates, which most physicians won’t. There is reason to be concerned about the adequacy of physician participation.

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