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Consumer

State Investigating Covered California Insurers After KPIX 5 Reports On Customers Not Finding Doctors

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Allen-Martin_BIO-HEAD Allen Martin
Allen Martin anchors the KPIX 5 newscasts each weeknight at 5 and 6 pm...
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SACRAMENTO (KPIX 5) — State regulators are investigating whether two large insurance companies,  Anthem Blue Cross and Blue Shield of California,  may have broken state laws by misleading customers who signed up for their plans through Covered California.

For months, KPIX 5 ConsumerWatch has been reporting on problems experienced by Anthem and Blue Shield customers who say they’ve been unable to find doctors in their area who are willing to take on new clients.   Customers have also complained about the large number of mistakes in the company’s provider lists.

More On Covered California Issues:

“I was on the phone with Anthem for two hours while they were trying to find a doctor within twenty miles,” an Anthem customer recently told KPIX 5 reporter Julie Watts. He said an Anthem representative finally advised him to cancel his plan.

Under state law, insurers must have enough doctors to enable patients to get an appointment within 15 days and 15 miles of their home.

The large number of inaccuracies in Anthem’s and Blue Shield’s provider lists will also be a focus of the State Department of Managed Healthcare’s investigation.   Dozens of individuals have complained to KPIX 5 that they based their decision to enroll in the insurer’s plans based on what turned out to be flawed information on those provider lists.

The state’s investigation is expected to take two months.  Insurers will then have 45 days to respond.

Marta Green of the State Department of Managed Health Care says penalties, if warranted, could include fines and increased monitoring of the companies.

A spokesman for Anthem did not comment directly on the investigation. He did email KPIX 5 a statement saying “Anthem Blue Cross continually works to improve the accuracy of our provider directory.”

Steve Shivinsky, a spokesman for Blue Shield of California, tells KPIX5 he was “surprised,”  by the investigation.  Shivinsky added, “We’re not surprised there’s confusion in the marketplace, because the market was completely changed.”

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