ConsumerWatch: Some Doctors Surprised To Be On Covered California Provider List

SAN FRANCISCO (KPIX 5) — After KPIX 5 ConsumerWatch revealed confusion over which physicians are accepting patients under Covered California, some doctors who did not want to accept patients on the exchange said they were surprised to find out they were on the exchange’s list of providers.

Last week, KPIX 5 reported on Covered California enrollees who found many doctors on the insurance exchange’s list wouldn’t accept them as patients. As a result of our report, Covered California removed the list of doctors from their website.

Independent physicians across California say they can’t afford to participate in Covered California’s insurance plans because the reimbursement rates are too low, and they say they don’t have the clout doctors with larger medical groups have to negotiate higher rates. They also warn that could mean a shortage of doctors in areas largely served by independent physicians.

Dr. Marie President is one of those doctors unhappy with reimbursement rates. The Redwood City internist said she was surprised to even find herself on a provider list published on the Covered California site. “We were astonished because we hadn’t signed anything yet,” President told KPIX 5.

Additionally, she says the reimbursement rates offered under the state’s plan aren’t realistic. Taking patients under those circumstances isn’t practical, President said. “We can’t, or we’ll be out of business.”

California’s medical establishment is also raising red flags about the situation. “There’s a concern about how these are structured, whether the reimbursement will be sufficient,” said Dr. Ruth Haskins of the California Medical Association.

The association said while the Affordable Care Act mandates what insurers charge patients, it does not regulate what they reimburse doctors.

For example, President said, if a doctor bills $134 for a standard office visit, a standard insurance policy will reimburse the physician $87. But under one of the new Covered California policies, the same insurer will reimburse the physician just $59. By comparison, even Medicare pays more, at $84.

“We can’t maintain operations at that level of reimbursement,” President said.

She added insurers do pay more to doctors who are part of large medical groups that negotiate with insurers on their behalf. “What’s needed is a standard reimbursement rate for physicians so there are incentives to accept those patients. If not, I’m not really sure what’s going to happen to those patients,” President said.

The insurance industry admits it’s a difficult situation, with no quick solution. The California Association of Health Plans told KPIX 5: “The Affordable Care Act promises good medical care at an affordable price…And that means everyone must be cost conscious.”

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