Stakeholders Push To Expand Covered Calif. Provider Networks

After Covered California released its 2015 rates last week, health insurance stakeholders in California now are focusing on expanding the provider networks for plans sold through the state health insurance exchange, the Sacramento Business Journal reports (Robertson, Sacramento Business Journal, 8/5).

Background on Network Issues

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.

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 (California Healthline, 5/23).

Efforts To Widen Networks Underway

Following the recent release of 2015 premium rates for exchange plans, stakeholders said the state now should focus on ensuring adequate provider networks in health plans.

Joe Hart, an insurance broker in Sacramento, said, "It's good to see these rates are lower than we thought," but "it would be nice to see expansion of the networks."

Many insurers already are working to widen the networks for their exchange plans. For example, Anthem Blue Cross since January has added 6,300 physicians to its network, bringing its total number of in-network providers in the state to 38,000. In addition, Blue Shield of California has added 40 hospitals and 15,000 providers to its in-network list over the past year.

Meanwhile, state lawmakers have introduced legislation aimed at addressing narrow networks in exchange plans.

One bill (SB 964) being considered by lawmakers would require the state Department of Managed Health Care to evaluate Medi-Cal managed care plans and exchange health plans annually to determine whether they are meeting standards for network adequacy, timely access to care and other metrics. Medi-Cal is California's Medicaid program.

Another bill (AB 2533) under consideration would require insurers to pay for out-of-network providers when an in-network provider is not immediately available to provide care.

Meanwhile, Lee said the exchange is working with DMHC to "make sure provider directories are spot on" (Sacramento Business Journal, 8/5).