Speak with a Covered California certified agent! Call (888) 413-3164 or Shop Online Now

Shop and Compare

California Health Insurance Plans and Rates

It's easy. Just enter your zip code.

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.


Cedars Doesn't Take My Insurance?

By on | 5 Comments

Question: My son has a preexiting heart condition. He needs to continue with his cardiologist who as treated him his entire life. What can I do to get coverage that cedars will take?

Answer: You can change plans during the annual open enrollment period. This year it starts November 15th. Your change of coverage will not be effective until January 1 2015. Work with your agent to find coverage that includes Cedars Sinai.

5 Comments

Hi Joey.

Yes, you found the correct PPO network for Assurant (ASA PPO), as you’ve listed.

And I understand your consideration of changing plans if you are not to be subsidy eligible.

However, if you are subsidy eligible based upon your anticipated household MAGI earnings, then forfeiting $1,370 per month subsidy and the very strong Silver 87 plan (which I consider a better plan than both Gold or Platinum), boy… I’m inclined to encourage that you stick with strong plan and rich subsidy… if you ARE going to subsidy eligible.

Yet, on the other side of this equation, is that if your access to doctors is much more important (as you have expressed), and you can afford a Silver or Gold plan without subsidy (health plan selection is often based upon your anticipated utilization of health plan benefits) then maybe a non-subsidized Assurant plan is appropriate for you.

Of course, I don’t quite know all your household specifics, so I must preface that my commentary may not be best taken as advice, yet do feel free to give me a call (click on my name for my contact info) if you would like to discuss further. I’d be glad to be your agent and to help.

Best,

Michael, thanks for the Assurant tip. This is the first time I have heard of Assurant. I did a quick network check, which is strangely Aetna’s Signature Admin PPO network, and so far all but one doctor and one lab is in network.

I need to call Assurant to find out more about their drug list/formulary. My wife had to get prior authorizations from Anthem for 2 of her medications. Drugs is a wild card if you need prior authorizations. I don’t think there is a way to get an insurance company to give you drug prior authorizations before enrolling in one of their plans. We are taking a risk enrolling in Assurant (or Cigna) only to find out later Assurant will not cover my wife’s expensive drugs.

Rate wise, Assurant, Cigna, and Anthem are fairly similar. The Silver plans all run in the $700 per month range.

Of course losing our huge $1,370 monthly subsidy is going to be a real bummer, including the Silver 87’s low deductibles, copays, and out of pocket max.

But we are also intending to move next year, and the capital gains are going to kick us out of the subsidy income range. But then, we may not find a home either, and may not move. Decisions, Decisions!!

Hi Joey, and original poster.

Assurant has Cedars Medical Group in-network.

Assurant is also available in Alameda County. I have many clients in Alameda County and the Bay Area, and Assurant is proving a go-to carrier primarily due to the strong large PPO provider network.

Contact me (click my name per this post), and I will help you enroll.

There are ways to get your self into a subsidized insurance plan that will give you access to where you need to go. You have to think out-side of the box.

Phil, where have you been living this past year? Don’t you know access to doctors (and “you can keep your doctor” is the biggest failure of Obamacare? The individual market offers no certainty you will “find coverage that includes Cedars Sinai”, or any doctor.

I, for example, live in Alameda county, zip code 94539. Through Covered California, I can only buy Kaiser HMO, or Anthem PPO. With Anthem’s Pathway X PPO, I have no access to Stanford doctors, John Muir doctors, Palo Alto Medical Foundation doctors, Menlo Medical Clinic doctors, etc etc etc. Additionally, most doctors within 50 miles do not take Anthem’s Pathway X PPO insurance.

I have also had many of my doctors cancel out of Anthem’s Pathway X PPO midyear because of Anthem’s poor reimbursement rates.

Anyone forced into Anthem’s Covered CA plans have almost zero hope of keeping their doctor, or finding a top notch doctor.

Cigna, which is the only other PPO plan available, and not subsidized or under the Covered CA umbrella, is my only other PPO option. However, Cigna’s network of doctors called “LocalPlus” is also a limited narrow network.

Obamacare is a joke, and has allowed the insurance companies free hand pricing their plans, shrinking the network of doctors, and reducing the doctors reimbursement rates so no top notch doctor/hospital will participate in their plans.

From what I learned by talking to doctors and Anthem reps, Anthem’s narrow networks is not so much controlled by Anthem, but by the doctors. Anthem is having trouble finding doctors to join their individual market plans because of Anthem’s poor reimbursement rates.

Also, doctors are very frustrated dealing with the narrow networks. One of my doctors recently canceled out of Anthem’s Covered CA plans because he could not find a specialist cancer doctor for one his patients, that would take Anthem’s Pathway X PPO insurance. His patient had a serious tumor and needed immediate care. He could not find any cancer doctors accepting the patient’s Anthem Pathway X PPO insurance in the entire San Francisco Bay Area. The patient ended up paying out of her pocket. The doctor became so discouraged with Anthem’s network, he stopped taking Anthem’s Pathway X PPO insurance, shrinking the network even further.

Obamacare has created a doctor access nightmare. No one in government, including Peter Lee’s lip service, seem to care much about fixing the ever shrinking access to quality doctors.

The insurance companies are loving it right now, as they have been reporting record quarterly profits. The insurance companies have turned Obamacare into a financial windfall at the expense of us individuals who have been forced to buy their crappy insurance.

Leave a comment

Do You Have California Health Insurance Questions?

Ask An Expert

View Previous Questions
Call Us at (888) 413-3164


© 2019 California Health Benefit Advisers, LLC
Home / About / Start Shopping / Ask a Question

“Covered California,” “California Health Benefit Exchange”, and the Covered California Logo are registered trademarks or service marks of Covered California, in the United States. This web site is owned and maintained by California Health Benefit Advisers, LLC, which is solely responsible for its content.