DMHC Launches Probe of Anthem, Blue Shield Provider Networks

California health regulators have launched an investigation into the accuracy of provider lists provided by Anthem Blue Cross and Blue Shield of California for plans offered through the state health insurance exchange, the Orange County Register reports.

Since January, consumers have filed 115 complaints against Anthem and 97 complaints against Blue Shield related to provider lists.

On Friday, state Department of Managed Health Care Director Shelley Rouillard said many consumers complained after selecting a health plan that included a specific doctor and then finding that the doctor was not actually covered by the plan's network.

Details of Investigation

As part of the investigation, health officials will contact providers in every county who are included on provider lists for the two insurers' exchange plans in search of potential violations of the law. Officials then will compare provider lists with contracts and providers' responses to surveys (Perkes, Orange County Register, 6/21).

DMHC spokesperson Marta Green said the agency's "preliminary investigation gave us good cause to believe there are violations of the law."

She said the investigation is expected to take about 60 days. Findings will be sent to the insurers, who will have 45 days to respond (Terhune, Los Angeles Times, 6/20). Officials said findings from the investigation likely will be released publicly by Nov. 15 (Orange County Register, 6/21).

Reaction From Insurers

Darrel Ng, spokesperson for Anthem, said that the insurer's database was found to have some inaccuracies earlier this year but that Anthem "continually works to improve the accuracy of [its] provider directory" (Orange County Register, 6/21).

Ng added that the insurer is working to fix any inconsistencies "with a priority placed on the regions with a higher number of inquiries" (Rauber, "Bay Area BizTalk," San Francisco Business Times, 6/20).

Blue Shield spokesperson Steve Shivinsky said, "We are redoubling our efforts to inform physicians and our customers as to what the network makeup is," adding, "If some corrective action is necessary as a result of the state survey, we will do that" (Los Angeles Times, 6/20).