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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.


Are Provider Directories Accurate Now?

By on | 5 Comments

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.

5 Comments

Michael, In most cases, the carriers need to staff up and add IT capability to solve their end of the “provider directory” problem. They are not going to spend that money now unless there are serious consequences for dragging their feet.

I would say I disagree with the suggestion that carriers need to be fined over provider directories. There are huge challenges in maintaining a directory of doctors. Doctors move, doctors die, doctors retire, and a small percentage of them don’t care or commit fraud. Doctors are responsible to notify they insurance companies about their office locations, their correct phone numbers, and all of the other things that everyone foolishly believes is so “easy” to maintain. Maintaining a directory is a two way street. It is impossible for an insurance company to keep tabs on the free movement, and independence of doctors and their staffs. The administrative burdens would create huge costs. This would need to be collaborative in more ways than you can count. In addition, while technology is always trumpeted as a solution to these things, technology is already in use, and it fails miserably in this area. Doctors complain vehemently about the costs to upgrade and “get with the 21st” century”. The reality is, the entire system is broke, and the solutions to this, and a myriad of other problems won’t be solved by tomorrow.

My advice: the last person to call about whether your doctor takes your plan or not is your doctor. You need to speak directly with whomever manages the doctors bills. These are the people who know what is going on - in most cases. And remember, get a name, and a title of the person you speak to. If you really want to dot an i or cross a T, write a confirming letter to them about what you were told. These are the lenghts of stupidity you have to go through in American Healthcare

Marie, many doctors offices still believe that they don’t take Covered California coverage, but they are actually in-network for some Covered California plans.

TO BE SURE, JUST CALL YOUR DOCTOR(S) AND ASK THEM DIRECTLY. THAT’S WHAT I DO.

After two years, there are still network-contracted providers who fail to realize they are supposed to provide services to subscribers whose ID cards happen to have the CoveredCA logo printed on them. This is a major communication failure between insurers and providers, and leaves insureds unable to obtain the services they are riightly entitled to, courtesy of the PPACA, CoveredCA, and their insurance company.

Subscribers who experience such problems should be encouraged to speak with Member Services to unlock a negotiated sooultion

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