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ConsumerWatch: Many Reasons For Inaccuracies In Covered California Directory

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(Covered California)

(Covered California)

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SAN FRANCISCO (KPIX 5) — Doctors, the insurance industry, and California’s medical establishment are shedding light on why there were so many inaccuracies in the now-removed Physician Directory on the Covered California website.

The reasons range from doctors opting out faster than insurance companies can update their lists, long-standing issues with accuracies on insurer’s provider lists, to confusion over whether doctors are required or not to participate.

“I feel like a baseball player that’s waiting for the season to start” Covered California customer Guda Venkatesh told KPIX 5 ConsumerWatch. The Menlo Park resident said with all the problems with the list, he has not been able to find a doctor willing to accept his Anthem policy.

Related Coverage:
Some Doctors Surprised To Be On Covered CA Provider List
Covered California Removes Doctor Lists After KPIX 5 Report Finds Mistakes
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The California Medical Association blames a big part of the inaccuracies on confusion over whether doctors are required or not to participate in Covered California plans. The Association said most of the insurers on the exchange have fine print to their contracts requiring that doctors in their networks accept Covered California policies. As a result, some of those doctors are mistakenly turning patients away.

Other insurers, including Anthem Blue Cross and Blue Shield, are giving doctors a choice. And many, particularly independent physicians, are choosing not to participate.

Some doctors told KPIX 5 that they are opting out because they said reimbursement rates for patients with Covered California plans are too low.

Adding to the confusion, insurers aren’t able to keep their physician lists updated.

Inaccuracies go beyond doctors being listed under Covered California plans they say they’re not accepting. There have also been reports that doctors have been listed as having the incorrect specialties, and that they were fluent in languages they couldn’t speak. KPIX 5 spoke with one doctor on the list who has been retired for a year.

Insurance experts said that’s in part because of a long-standing problem with inaccuracies on provider’s physician lists.

Customers aren’t the only ones complaining. Redwood City based internist Dr. Marie President said she is frustrated, about her inability to check what specialists are available to see her patients. “How do we know where to send them?” President asked.

Covered California denies physicians can’t get the information. Spokesman Dana Howard said doctors should check their contracts.

Howard said Covered California is reviewing the issue of inaccuracies on the physician list. He said if the agency discovers insurers tried to falsely claim they had a more robust list of providers, regulators will take action to remedy the problem.

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