Question: Before I purchased my Covered California plan with Anthem last year, I carefully checked Anthem’s online provider directory (Covered California does not appear to have one) to confirm that my doctor, my wife’s doctors, and our preferred hospital were all in-network. When we visited our doctors a few months later, both of our doctors told us they do not take Covered California. This cost us significant out of pocket expenses. Is there any I can get reimbursed for their mistake? Is it any better now?
Answer: Today’s provider directories are somewhat better than a year ago, but are still inaccurate. (For a complete picture on why this situation continues 2 years after ACA implementation read: Provider Directory Study 9-2015.pdf. Accurate provider directories won’t happen any time soon. We need the Department of Insurance and the Department of Healthcare Services to “grow a pair” and start aggressively enforcing existing standards with sanctions and fines for the carriers. Covered California should add an SEP trigger to include consumers that can show that they chose a plan based on inaccurate provider directories. That way at least, the consumer could switch plans and minimize the added cost and inconvenience caused by errors or misrepresentations in provider directories.