Consumer

State Investigating Flawed Covered California Doctor Lists From Insurers

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Julie-Watts_BIO-HEAD Julie Watts
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SAN FRANCISCO (KPIX 5) — For months, KPIX 5 ConsumerWatch has been investigating consumer complaints about Covered California insurance policies.  The months long investigation uncovered everything from too few doctors to complaints of insurance bait and switch.

KPIX 5 notified the State Department of Managed Health care of its findings, and now state regulators have finally launched their own investigation.

More On Covered California Issues:

In a statement, the Department of Managed Care confirmed to KPIX 5 “it now has reason to believe” Anthem Blue Cross and Blue Shield have broken the law. The state agency said it has finally begun calling doctors to find out if they are actually accepting patients with Covered California plans.

Julia Turner was caught in what she described as an “insurance bait and switch.” In her research, she found that her doctor was listed as in-network on the Covered California provider directory. After signing up for the coverage, she found out otherwise.

“If I wasn’t going to have access to my doctor, I would have chosen a different insurance,” said Turner.

Turner contacted KPIX 5 ConsumerWatch for help.  But her search for doctors doesn’t end there.

She went back to the same provider director to find a new gynecologist, since hers wouldn’t accept her new insurance. But the closest gynecologist she could find near her Alameda home was actually 45 minutes away in Napa.

“Who in their right mind is going to drive up to Napa, when I’m two miles away from Summit Medical Center?” said Turner.

Again, ConsumerWatch contacted state regulators about Turner’s frustrating search, pointing out the lack of doctors.  State regulators consulted the insurers’ list and provided what it thought was an updated list of nearly 90 OBGYN’s within five miles of her home.

But the state agency apparently didn’t review the list or it would have found what KPIX 5 found.

After calling every doctor on the list, ConsumerWatch found only one OBGYN in all of Alameda who is actually accepting her insurance.

“This is one of the very basic things, can you find a doctor?” asked Turner.

The DMHC said it is now in the process of surveying doctors to identify inaccuracies and inadequacies like these.

State regulators declined to sit down for a follow-up interview after making a recent announcement that it was investigating Anthem Blue Cross and Blue Shield for possible violations of state law.

But in February, Marta Green of DHMC told KPIX 5, “If a health plan willfully misrepresents to the Department of Managed Health Care any aspect of a license filing that is a serious violation of the law.”

At that time, we asked the state if it checked the provider lists for accuracy. “We do spot check those lists of providers that the plan represents are in contract with them,” said Green.

It’s questionable if those checks were done. Because several months after that statement, that same office revealed it would finally be checking with doctors on the lists to see if they are indeed offering Covered California coverage.

Turner said, “The fact that they haven’t actually been checking if they’re in the network, it blows my mind.”

Blue Shield said “It is committed to working with members like Julia to identify appropriate specialists and said it’s making regular updates and improvements to its provider site.  Meanwhile, DMHC pointed to the investigation it announced last week and said if it finds inaccuracies, it will correct them.

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