Covered California Urging Insurers To Expand Provider Networks
In response to consumer complaints, Covered California is urging insurers to expand their provider networks ahead of the next open enrollment period, officials said during an exchange board meeting Thursday, KQED's "State of Health" reports.
Details of Complaints
Consumer advocates have been pushing the exchange to call for expanded provider networks after some individuals who purchased health plans through the exchange had to change doctors.
For instance, some pregnant women were forced to switch obstetricians late in their pregnancies because their current physicians were not covered in the network of the plan they selected, according to "State of Health."
In addition, some Oakland residents were unaware when they purchased an exchange plan did not include providers in nearby San Francisco in its network.
Covered California Executive Director Peter Lee said about 200 complaints about access to care have been filed to the Department of Managed Health Care since January.
In addition, a recent survey by the California Medical Association's Center for Medical and Regulatory Policy found that 55% of physicians had trouble finding in-network providers for patient referrals.
Details of Board Meeting
During the meeting, Lee said the exchange is working to resolve the complaints as it negotiates contracts with insurers for 2015. Lee said, "We're doing very active monitoring and in particular in coordination with the Department of Managed Health Care to investigate and assure that plans' networks are adequate."
Lee said the exchange is encouraging insurers to expand their networks. He said Anthem Blue Cross, Blue Shield of California and Health Net have responded positively and "have done significant work in the last quarter to expand networks."
For example, Anthem said it has added 3,800 physicians to its network since January, while Health Net said it has expanded its network by 64%.
However, Athena Chapman, director of regulatory affairs for the California Association of Health Plans, cautioned insurers against expanding their networks too broadly, noting that "[t]ailored networks maintain affordability" (Dembosky, "State of Health," KQED, 5/22).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.