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Anthem "Find a Doctor" Confusing?

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Question: We enrolled for the Anthem Blue Cross Preferred Direct Access Pathway PPO plan. My PCP is part of Palo Alto Medical Foundation / Sutter Health. When I lookup his profile directly from Anthem’s website, the insurance plans he accepts show “Preferred Direct Access - CA”. He also shows the other tiers offered - Core, Essential, Premier Direct Access of the Pathway PPO and Guided Access HMO plans available through Anthem BC for 2014. But if I login to the Anthem website as a member, the search does NOT include my doctor s “In-Network” under the Pathway PPO /Preferred Direct Access Plan. This is true of most if not all doctors from PAMF listed on Anthem’s website.

Answer: The name “Preferred Direct Access” refers to gold-level plans in Anthem’s small-group plan portfolio and off-exchange individual and family plan portfolio. “Pathway” is the network name used by all individual plans effective 1/1/14 and later. “Pathway X” is for Anthem individual plans sold through Covered California. he Pathway X network is exactly the same as the Pathway network without the X. When using the Anthem “Find-a-Doctor” online app, select the Pathway network first, then the plan type and name.

29 Comments

It’s been a disaster. I have been trying to find and get an appointment to a PCP for over a month! Calling basically to EACH number in the list they provided me or list from the Find-a-doctor tool (which give completely different results). And either the doctor listed doesn’t exist, either they left, or the phone number is incorrect, or the doctor has passed away, or they don’t accept Pathway PPO plan.

After wasting hours on the phone both with clinics and anthem BC representatives, I’ve got an appointment for a clinics that was listed (doctor’s name of course was wrong). Waiting for almost a month for an appt, I came to see the doctor and guess what?! I’ve been told that they don’t accept Pathway PPO! Even though their admin also confirmed that they accept while scheduling a month ago.

So far, my problem has worsened substantially without any hope to get an appointment in the near future.

I agree with many of the comments on Anthem “Pathway”. It feels borderline fraudulent. Or at least obfuscated to a level where a normal consumer won’t find out all the issues until weeks or months into the plan and then you are screwed because of open enrollment period issues.

I am on Anthem Platinum Pathway plan and the biggest hospitals in my area PAMF and El Camino Hospital are not part of the network!!!

Someone should do something about this.

It has been a nightmare dealing with Anthem Blue Cross. New applications sent from my Company received by priority mail on 9/30/15 and confirmed by postal delivery. Nevertheless Anthem denied receiving the applications. Furthermore, my wife who was on Cobra, called to follow up, was told she was cancelled for supplying the wrong application (it wasn’t wrong), and she spent 2 hours given the run-around by 5 different departments. They also claimed that application arrived 2 days late (contradicts post office). Furthermore, the previous Anthem Blue Cross insurance she had doubled with no warning, and the replacement insurance (Anthem Silver Pathway) was supposed to have the same coverage as previous. Unfortunately, few doctors are covering Anthem Silver Pathway, even though it is 20% more expensive than previous insurance she had (assuming similar deductible). Anthem Blue Cross obviously has no clue what is going on, and furthermore there staff is incompetent.

AW, You should be happy you pay only $400 a month, I pay $1,261 a month and get virtually nothing for it. I have insurance because I have to and for catastrophic medical. What a joke this medical insurance is..

YES! I am nearly in the same situation. My plan is over $400 a month. I received numerous high-cost bills last year, because even though the insurance provided in-network paper said my doctor’s would be covered, they were not. Today, I called the insurance company and asked them to send me a copy of their latest in-network dentist providers for my local area. The absolute nearest one is 45 minutes away from the address that I used when I signed-up a year ago. So far, FOUR of the doctor’s on the list I was given by Anthem BC/BS are NOT in-network! In fact, one Dr. on the list has been deceased for eight years I was told. I am now struggling to find one of the 30 offices they gave me info on to even accept my insurance. For $400+ a month, this is what I get?? This seems criminal to me.

Please can someone help me. both my husband and i are sick. we need to find a clinic soon. we were members of sutter health but no they dont accepth us. we live in sunnyvale we are silver 70 ppo. we need a pcp as soon as possible. please recommend a network so we can get checked. Thank you

Shirley: Get a certified health insurance agent to help you find a plan that includes your doctor. Here’s a link to find an agent http://www.coveredca.com/get-help/local/#null

I mistakenly missed a payment, after insurance for 16 years with blue shield ppo. When I contacted them to clear it up they said it was cancelled and they would re-enlist me but not until 1/1/15, so I had no insurance for a month. Now, when I went to my usual doctor they won’t take it because I have pathway ppo. It is useless. There are no good doctors in this plan.

Everyone here has the same complaint but is there a solution out there? Any insurance companies that will allow us to use our own doctors? I am paying over $700 a month for just me and now I have to pay for my doctor visits too. What else don’t they pay for?

Pls contact me directly to explore amassing unhappy consumers of this plan that need a solution.

Here is the CA medical insurance commissioners page:

http://www.insurance.ca.gov/0500-about-us/05-contact/

I just complained using the email of the dept below: California Department of Insurance Fraud Division 9342 Tech Center Drive, Suite 100 Sacramento, CA 95826 fraud@insurance.ca.gov <————THIS ONE

This situation is no joke as many have put it. We are losing thousands of dollars per month in premium and out of pocket payments !! Maybe a lawsuit is in order - class action at that.

Health Insurance has become laughably pathetic in the last ten years, and the ACA (while crafted with the best intentions) has done nothing to fix it.

My old plan did not “conform” apparently, and was cancelled. Strangely, there are no providers now for my area except Anthem Blue Cross. Yipee. The Covered California provider look-up was not working when I was signing up last year, so I looked up my local hospital and physician group before I signed up, and found them on the Anthem website, so I thought, no problem. After I got my plan and went to my doctor, I was informed that they did not accept my plan after all. It turns out that the plan is accepted by my local hospital, but not by the hospital’s LAB! The plan is also not accepted by my physician, who IS in the same medical group as my hospital! Whaa? I have been paying out of pocket for all medical visits for the last year, in addition to paying my premiums.

OK, renewal time. I thought, I am going to look around for real insurance, because this insurance is not insurance. I went online, and the only insurance provider to offer individual plans in my zip code (not only on covered california, but generally!) is Anthem Blue Cross. And we know how that works. I feel stuck here - I am thinking that I will probably be better off now just paying the penalty for not having insurance and pay doctors out of pocket instead of paying the premiums and the doctors out of pocket anyway.

Anyone else coming to the same conclusion? Anyone have any other suggestions?

I just canceled Anthem Pathway X after 6 months. I called over 300 doctors and none of the doctors on Anthem’s website would accept the Covered California plans. The nearest hospital to me doesn’t accept this plan so no emergency coverage either. An insurance plan with no providers is no insurance at all but I’m the one whose going to have to pay a penalty. Who is going to penalize Anthem

I too just discovered my doctor does not accept this Anthem Blue Cross Pathway X PPO even though he was listed when I signed up. Look so many of these posts this health insurance is a TOTAL waste of money and should not be sold through Covered California. It is a fraud !!!

We also have the worthless Anthem pathway here in Fresno CA. Excuse me, we pay over $1,000 a month, so not worthless to Anthem. Drs. on outdated list will not accept this insurance or if they do they have poor ratings and you would not want to entrust your health to them. We have had to pay out of pocket for dr. visits also. Anthem has yet to apply the costs toward deductible. Could not find help with painful broken arm! …this ain’t no joke people!

Covered California sent over the wrong DOB for me to Anthem Blue Cross. Blue Cross deducts from my checking account automatically every month. When a doctor or lab bill is sent to them, they say there is no one with that info in our system. I have spent MANY HOURS trying to resolve this and Covered California has done NOTHING to resolve this, which has been going on for months. Now, one of my lab bills has been sent to Collections. HELP!!!!!

My wife and I had a Blue Cross plan before the ACA but the plan apparently did not meet the ACA requirements so we lost our plan. Our president told us we could keep our plan, guess he didn’t know what was in the plan himself. He also told us we could keep our doctor. Not one doctor in my home town accept the plan we now have, which I am told is not a Covered Calif plan but not one office will investigate to determine if there is a difference.

This medical insurance is a huge mistake and a huge mess. Never thought I would be priced out of the medical insurance market but our premiums have increased and we essentially have no coverage. My wife just spent over an hour on the phone with BC and got no where. Angry? You bet.

My Anthem Bluecross “pathway PPO” plan is completely useless. I’ve had to pay for multiple doctors appointments out of pocket, because I cannot find a doctor covered under the pathway PPO plan. They’ve also denied a prescription that a doctor wrote me, which will cost me $850 a month out of pocket. I cannot express how disappointed and angry this makes me. The pathway PPO plan is garbage, and I feel cheated. I do not understand how this plan still exists, it’s fraudulent.

This is absolutely the worst plan I have ever had. Every doctor I have attempted to see for possible hip surgery does not take anthem BC pathways. The website to obtain a listing of avail drs is next to impossible to access and calling them is at least a 1/2 hour wait. None of this was addressed when I bought the plan and I have a premier plan. The calif ins commissioner seriously needs to get involved in this matter.

Anthem Blue Cross vs Anthem Blue Cross Covered CA! I had given up trying to get coverage on the terrible CA site, and applied directly to Blue, but my insurance card says “Covered”. So, now my doctors tell me that they take Anthem Blue Cross insurance, BUT DO NOT take Anthem Blue Cross “Covered”. We are canceling this insurance ASAP and going with something else. Altho Kaiser has already given us the “you know what” when they canceled our GREAT plan, and replaced with 20% rate increase, higher deductable, lower coverage, etc., etc.

Yes the whole thing’s outrageous. My comments are a bit different… I was told by coveredca when applied back in Nov/Dec that since I was back and forth from Calif to Illinois, I should get multi-state plan (got Blue Anthem Gold). So I’ve seen Illinois blue cross Doctors this year—who would take my card,tell me my deductible—and SOME of which would even get paid by Blue Anthem. But NOW they’re rejecting EVERYTHING saying Multi-state plan DOES’T MEAN you get coverage in multiple states! SURELY not what I was told before… Additionally, over 1/2 my RX’s I’ve taken for years (including no problem with PCIP) get Rejected; some aren’t on their drug list(!); most require “pre-approval”… Wow, sure glad I don’t have cancer or something… Does anyone have any advice about appealing, complaining, etc??

I agree, Anthem has gone from bad to worst. None of the doctors on their site take this stupid pathway ppo insurance, and they claim to update last list every week! They are perhaps the worst health insurance provider I’ve ever had. I’m switching to something (anything) else.

When I did call and talk to someone after a 20minute hold, they had just excuses for “working out the kinks” of their find a doctor service. There are no kinks, it’s fully broken!

anybody else notice that the iphone ap does not show the same results as the website?

even clicking find doctors in my plan, its showing all the results, even thought the 2 other choices for looking for plans have their own fields just like on the website.

i thought i found a doctor that was recommended to me weeks ago for an issue, i have an appointment and went to get the address and now it doesn’t show as being in the network.

can’t say i am like the plan either thus far, having trouble finding good care, let alone somebody within 100 miles.

Try zip code 95992, with a 5 mile radius. For whatever reason, when I entered zip 95991 and 95993 the Find a Doctor only found a few doctors. Zip 95992 returned a lot of doctors.

I need a current list of doctors in Yuba City, CA who will take Anthem Blue Cross Pathways insurance. The doctors listed under the “Find a Doctor” will not accept the Pathways insurance even if your insurance is not government subsidized.

cannot find a doctor or anyone that takes my calif pto plan in either yuba city or marysville ca area who is the closest this is a very bad plan no one is getting any help with this problem , maybe president should rethink his great plan.

Sean, I logged into Anthem using my ID and changed the zip to a Sherman Oaks 91401, and Richard Nussbaum is in-network with “Anthem Blue Cross Silver DirectAccess, a Multi-State Plan-CA”, which is your Silver 94 plan.

When you search, make sure to change the SPECIALTY to Orthopedics (or All Practices). The FIND A DOCTOR defaults to Family/General Practice, which will not find Richard Nussbaum.

I picked the Anthem Blue Cross, Silver 94, plan, as it showed Dr.Richard Nussbaum, in sherman oaks, CA, as accepting the plan. However, when I went on Anthem site with member ID, he is not listed. I need him as my surgeon and cannot understand why he is not showing up, under find my doctor anymore?

I’ve tried the Anthem website Find Doctor search with both exchange and non-exchange policies, and none list any hospitals on their approved list within 100 miles of my location! Does that mean I wouldn’t be covered at all by Anthem’s policies if I had to go in the hospital? In contrast, Blue Shield’s website hospital list for their exchange-based PPO policy does list a nearby hospital, but Blue Shield doesn’t have my doctors like Anthem does. Will Anthem “fix” their hospital and doctor list in the near future?

The number of opthamologists is very small (3) within 10 miles of my location as well, and one of those is apparently not taking new patients, and another is age 65 so is probably retiring soon. My previous longtime eyedoctor retired and I need a new one now for maintaining glaucoma treatment.

Unfortunately, based on the PAMF website, PAMF does not accept Covered CA Anthem PPO, the Pathway X and/or Pathway network. www.pamf.org/physicians/healthplans.html Scroll to the bottom of the page to the Covered California section. Anthem is not on the list.

Anthem’s Find a Doctor is not accurate, and has not been updated since December. Other examples of errors - Menlo Medical Clinic shows In-Network with Pathway X, but is not. John Muir Health Hospitals/Medical Centers show In-network with Pathway X on Anthem’s website, but is not.

IMO, Anthem is being grossly negligent in not keeping their Find-A-Doctor up-to-date, and should be fined, or called to the carpet, by the State Insurance Commissioner.

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