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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.


When Will Provider Directory Be Available?

By on | 11 Comments

Question: Who’s going to buy health insurance when they don’t know if their doctor takes it or not? When will the Covered California post an accurate provider directory?

Answer: Covered California will probably try to get a consolidated provider directory back online as soon as possible, but it will remain somewhat inaccurate. That’s because the exchange gets provider data form the carriers and the health plans participating in the exchange are still negotiating rates with providers and health care systems. The narrowing of networks, compared with employer-based coverage, is causing more tension than usual between carriers and providers during negotiations. In some cases, the negotiating will go on right up to the Jan. 1, 2014 starting date.

11 Comments

Please advise how to find directories for Healthnet, Blue Shield and Blue Cross accepting Covered California. Also, what is on and off exchange? Your site is the first that has useful information. Thanks for your reply!

I have read several Affordable Care blogs and am therefore not surprised to find I am not the only one who is completely baffled by this whole process. The idea of affordable health care seems to have become yet another pipe dream. As the lower income subsidies will permit previously uninsured or under-insured, or recently terminated candidates, in the long run, what it is doing is increasing the cost to employers and all other health insured people to help cover the loss while at the same time over-inflating the monthly premiums for the new applicatants so that the states and Federal subsidies will make up some of their lost revenues. In the end, the cost of health care will not go down, but exactly the opposite.

My objection to all of this is that the frustration that we all feel is due to the complete disconnect between the Insurance Companies and the Government exchanges. They sat down and negotiated guidelines, but then forgot to dot all their I’s and cross their T’s, because quite frankly there isn’t a shred of credibility left in the lack of relevant and backed-up information on their websites. Doctors that are claimed to be part of a program when called state that they are NOT. Medical Groups that are listed have not been signed up, and from the doctors’ perspective, a complete lack of trust that insurance companies will pay even the portion of the claims that their programs claim that they cover. I spoke with many doctors who have stated that they are actually seeking a way out of their own professions because they just don’t see that they will be able to cover their costs with the sparse amounts that they may receive from the exchange based insurance programs.

My last calls to the individual insurance company customer service phone lines have told me that everything will be ok. They are beginning to send out the billing statements to the approved applicants for their first monthly premium. Their response to the question, but I don’t even know if the doctors I want will be part of the program, their answer was, you can always change your program or select another doctor after you are initiated and have your medical ID number. There’s nobody you can complain to because nobody cares, and nobody is listening. The concept of affordable health care is a noble one, unfortunately you may need to be of noble birth in order to find care in any of these programs.

I am super frustrated trying to figure out whether my family’s doctors are in the network for Anthem, Shield, and Healthnet for Orange County. I checked the directory information from the Covered CA website and the doctors’ offices, and got conflicting information. Today I tried to call Anthem, and they said a bunch of providers were on the network that didn’t show on their online spreadsheet. They couldn’t even tell me which level of EPO plan these providers were on. For example, one provider I called said that they opted out of all the exchange plans, but still showed up on Healthnet’s website. One provider felt fairly confident (based upon filling out forms) that they were on Anthem and Shield, but online showed up on Shield and not Anthem, but was confirmed to be on the network when I called Anthem. One provider said that they were rejected by Anthem to be on their network, but when I called Anthem, they said the doctor was on the network! I had heard that Anthem was the only company with the UC system doctors. However, Healthnet still has them and the hospitals on their network, according to the website. I was going to call Healthnet and Shield tomorrow, but my big question is which source of information can I really trust? Obviously having my same providers is really important to me, but how can I get accurate information??

Thank you for the reply. I actually checked the health plan directories individually since they allow the choice of the specific 2014 plans and searching by many criteria. Interesting HealthNet now shows over 1200 physicians, but when you narrow down to the specific plan product for 2014, it narrows to 25, and they no longer have the specialty I need listed in the dropdown menu.

I’ll keep checking periodically, but am certain it will be a very narrow network since the bronze & silver plans pay providers the least - - - and a reason the practice I was at for 11 years chose to opt out of those and all Medi-Cal HMOs. Private offices have to make overhead, and the government regulations (eRx, EHR, PQRS, OSHA, HIPPA/HITECH & the rest of the alphabet soup) cost a pretty penny to keep up with, let alone having to worry about payer contracts, loopholes, all products clauses, etc.

I also recall HealthNet had ZERO contracts at any of the hospitals where my employer physicians were credentialed. While IPAs and Medical Groups tried to tell the Pediatric Ophthalmologist he must credential with one of their contracted facilities, they backed down once they figured out he was a rare breed, and one of only two providers of his subspecialty on some of the plans.

I know I’m on a soapbox here, but as a consumer, a former practice manager and a caretaker for elderly parents, I see it from all angles. We didn’t need HEALTH reform…we needed INSURANCE reform and all this “you can keep your plan” hype where people have been canceled as their plans were “not adequate” leads me to believe Obama should have mandated the insurance plans include the mandatory care…force them to ADD the benefits, don’t allow them to get rid of the policies & replace them with higher premium, higher deductible plans that pay providers less. The American people get the short end of the stick and it’s sad because they don’t know health coverage doesn’t mean you actually receive health care - at least not quality care in a timely manner from doctors and staff that are not overworked and underpaid.

Again, I appreciate your response and am trying to muster up some hope. Thank you!

Is anyone having any luck getting any plan specific marketing information suitable for client presentations. All I can do is run the quite quote and take a picture of the screen shot. I am hoping that a nice matrix or…

It’s been impossible not to notice that Blue Cross is putting on a disastrous effort. For weeks there has been no search capability, and even now when you click on their links for counties you get a file downloaded that is unintelligible and impossible to decipher.

I do not believe they are integrated fully yet into Covered CA. This is outrageous, as the UCSD Health System, which is HUGE, has decided to go with Blue Cross but is not truly visible to Covered CA shoppers.

I went with Blue Shield. When you add in the fact that they are the only PPO, it becomes a no brainer for me.

What is going on between Anthem Blue Cross and California Department of Insurance? What has Blue Cross done? At this rate, the Department of Insurance is going to put Anthem out of business. With no rates and plans, forms or networks approved for off-exchange business, something is up. What’s up? Doesn’t smell right!!! Blue Shield and Health Net are fully functional. Three weeks into the race, Anthem has not even been released from the starting line. Forced redistribution of clients/business?

So the Covered CA search engine is up and returning providers. It works pretty darn well from what I’ve seen.

One important point about search capability. Since the Covered CA engine doesn’t allow for mileage as a filter, it’s hard to say what is going on in the code if you feed in a particular City or Zip Code.

Be aware that if you put “San Diego” as the text to search on, it will not return providers who have their office location as La Jolla. Even though La Jolla is not a separate city, but just a community within San Diego.

There are a ton of providers with La Jolla mailing addresses; Scripps and UCSD Health to name a few.

I live near the California state line, so all the doctors/hospitals reasonably close to us are actually in a different state. Will Covered California providers be only California doctors/hospitals? (So we’d have to travel even for urgent care?)

Is the Anthem/Blue Cross PPO network smaller than the “standard” (non-exchange) Anthem PPO network?

And on a different subject, I would qualify now for a subsidy. But if I get a new job next year with higher pay, I’d have to repay the subsidy amounts if the TOTAL bumps me over the limit, yes? (i.e. it’s not pro-rated/subsidy allowed for months I work at the lower pay level)?

The information out there is really not very clear for people who don’t fall into standard categories!

Thanks!

Bartholomew, based on an earlier Q&A on this site, you can change your plan for any reason any time during open enrollment, which lasts until March 31, 2014. So yes, you will be able to change your mind if your doctor turns out not to be in your plan.

But the way I read the answer to this particular Q&A, the list today is only going to be improved by January 1. All doctors who have already agreed to be a provider should be on the list. But new doctors will get added as they negotiate with the insurer and agree to be a provider. So I read it that it would only get better, not worse (assuming that your doctor doesn’t change their mind or the list is wrong, a strong possibility).

Beautiful.

Can one change their selected plan before Jan 1 2014 if they find out their doctor is not in the network of the insurance plan selected?

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