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It's been a year since many people discovered that the lists of doctors accepting Anthem Blue Cross' and Blue Shield's Covered California plans, both locally and beyond the borders of Humboldt County, were wildly inaccurate. Many of the doctors and specialists that the insurance companies promised policy buyers would accept their new government mandated insurance had not, in fact, agreed to reimbursement contracts with the insurance companies. Other doctors had moved or retired.

That caused a stink — enormous class action lawsuits, strong words from our congressman and other government officials, frustration on the parts of local doctors and insurance brokers. But it's unclear if any progress has been made.

"The first thing to say is, I don't really know," said Humboldt Independent Practice Association CEO Martin Love. (Love's organization doesn't deal directly with Covered California). Mostly it's "chatter and gossip," Love said, with little hard data. Most doctors are pretty quiet about their reimbursement contracts with insurance companies, as they can vary widely.

"My overall impression is that many more providers are contracted than were," Love said. "But I hesitate to say that I know anything."

Penny Figas, executive director of the Humboldt-Del Norte County Medical Society, said neither she nor anyone she works with has had time to pore over the most recent iterations of the provider lists for accuracy.

"Last time I looked at the list they hadn't cleaned much of it up," she said. "It's quite a chore to go through these lists and weed them out."

But out-of-date provider lists are only part of a much larger problem on the North Coast, Figas said: an alarming lack of doctors exacerbated by a growing number of people with insurance.

"It's pretty frustrating that we have a big open enrollment period for Covered California and there's really no one for them to see," Figas said. "Every office is trying to recruit new physicians to the area."

North Coast Congressman Jared Huffman said, at least when it comes to the condition of network provider lists, things are slowly getting better. "I'm only hearing anecdotally at this point, but I am hearing about improvements. That accountability and improvement is because, thankfully, a state enforcement agency did its job."

The state began investigating the matter as a result of problems with the first enrollment period, starting with a massive phone survey to California doctors to find out if they were accurately listed as in-network providers for Anthem Blue Cross or Blue Shield.

The California Department of Managed Health Care released the results of that survey in November, finding plenty of inaccuracies and "an unacceptable consumer experience."

The survey found that, statewide, 12.5 percent of physicians on Anthem's in-network provider directory were not at the location listed, and 12.8 percent of those listed at the right location were not accepting Anthem's plans under Covered California.

Blue Shield's list of in-network physicians featured 18.2 percent who were not in the location provided, and, of those who were, 8.8 percent were not accepting Blue Shield's Covered California plans.

The inaccuracies in Humboldt County were much sharper ("Bait and Switch," June 12, 2014).

Follow-up surveys are planned this year to ensure the listings are corrected and, according to spokesman Rodger Butler, the department's enforcement branch is pursuing corrective action "due to the seriousness of the deficiencies and the plans' failure to promptly correct them."

It's unclear what those penalties might be.

"My experience with [the Department of Managed Health Care] is they tend to be pretty light on their penalties," Huffman said. "I hope whatever they should do is meaningful enough to drive change in the industry."

California Insurance Commissioner Dave Jones issued an emergency regulation at his Jan. 5 inauguration, stiffening requirements for insurance companies to maintain accurate in-network provider lists.

"Californians and California businesses deserve better than what they have gotten from most health insurers and HMOs," Jones said.

The new regulation requires insurance companies to publish accurate provider lists, include "adequate numbers" of primary care physicians accepting new patients on those lists, make arrangements to provide out-of-network care at in-network prices when there are insufficient in-network care providers, and report frequently to the insurance commission, among other things. If insurance providers don't comply, the commission can prohibit them from selling insurance in California next year.

Huffman said the pressure from the commission should address some of the worst problems of the woefully inadequate networks.

Meanwhile, Consumer Watchdog, a California-based nonprofit advocacy group, has filed class action lawsuits against Anthem Blue Cross and Blue Shield, accusing the companies of misrepresenting their in-network provider lists, among other things. Each of those lawsuits, which are pending, represents about 500,000 people who bought policies during the first open enrollment period that ended last March, explained Consumer Watchdog attorney Laura Antonini.

Since then, Consumer Watchdog has filed similar suits on behalf of people who purchased policies from Health Net and Cigna, though it doesn't appear anyone on the North Coast is selling policies from any providers other than Blue Shield and Anthem Blue Cross.

That needs to change, Huffman said. "The other thing that would drive [change] is competition — incentives, if not requirements, so carriers that come into California and enjoy the benefits of all these new customers don't cherry pick the regions they provide insurance to."

Covered California

At a glance

1.2 million — number of Californians who purchased subsidized health insurance plans under Covered California

5,679 — number of Humboldt County residents who purchased Covered California plans last year

$46,680 — If you're single and your income is less than this, you qualify for either Medi-Cal or a Covered California plan

$95,400 — If you have a family of four and make less than this annually, you qualify for Medi-Cal or a Covered California plan

4,000 — Estimate of Humboldt County residents who became eligible for Medi-Cal last year under the Affordable Care Act

How to enroll

Call Covered California at (800) 300-1506, visit it online at www.coveredca.com or call Humboldt County's local call center at (877) 410-8809 before Feb. 15.

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About The Author

Grant Scott-Goforth

Bio:
Grant Scott-Goforth has been an assistant editor and staff writer for The Journal since 2013.

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