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Covered California Q&A

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.


Conflicting Provider Directories - Who to Believe?

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Question: I just signed up for Health Net PPO - Enhanced Silver. I am confused by the conflicting info on provider networks. EG, on CC website California Pacific Medical Center (CPMC) is NOT in network. On HNet website, using CC-PPO as the filter, CPMC is IN network for 2014 for that plan. CPMC’s own website says it is “in process of negotiating” with Healthnet. Who do I rely on? When will I be able to know FOR SURE whether Hnet covers this hospital? Any guidance will be appreciated. Is it safe to think that Health Net will honor its OWN provider directory for its Covered California plans?

Answer: I can provide guidance, but not a definitive answer. In this scenario, the Health Net website listing of its Covered California PPO network is more likely to be up to date than the other choices. My guess, we won’t be “sure” about the accuracy of the carrier network listings until mid-January. As for Health Net “honoring” an inaccurate listing: they will not provide in-network coverage for a provider who was erroneously listed. You will however have the option of changing plans,including carriers, even beyond the open enrollment period if you erroneously picked a plan without your desired provider(s).

3 Comments

I am also having this problem; on October 30th I was able to view the Doctors Providers on Covered California Exchange but when I checked with one that was on the list yesterday, January 6th, they are no longer accepting Covered California Insurance. Can I just change to private insurance up until March 31st as I’m not getting any premium assistance?

I used the CoveredCA “Find MY Doctor” to check in network Providers for clients back in late October/early November. At that time there were green boxes and red boxes and sometimes red and green boxes ( if able to check multiple doctors at same time- not able to lately). Searching those same doctors now yields different results….I had even looked to see which of my Doctors were in networks and found all of them listed as Blue Shield PPO providers, only a couple as Anthem Blue Cross and naturally none showing up in Kaiser. A recent look shows none of my Doctors under Blue Shield and a couple but not all under Anthem BC. More glitches???…more problems ahead

Would it not be a good idea to inform consumers that the physician and hospital networks are changing dramatically? There may be a major problem when those who signed up find out for example that Hoag Hospital is not a primary provider with either Blue Cross or Blue Shield. In my opinion this needs to be publicized.

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