SAN FRANCISCO (KPIX 5) — A growing number of people who purchased health insurance through California’s state run exchange are complaining that they were misled about the availability of physicians in the network. Some are calling it a bait and switch.
Brent Undridge is one of those complaining. The Castro Valley resident said when he signed up for a Covered California plan back in December, he was led to believe he could continue seeing the same medical group he has been using for the past two decades. But that did not turn out to be the case.
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“I wanted to cry,” Undridge told KPIX 5 ConsumerWatch. “I’ve been going there for 26 years, I really like them and want to keep them as my doctors.”
Part of that expectation stemmed from President Barack Obama’s oft-repeated promise while campaigning for the Affordable Care Act that “If you like your doctor, you can keep your doctor.” A promise, the President later admitted was not accurate.
And it’s expected more Californians could find themselves in the same situation as Undridge as more and more doctors are opting not to accept Covered California patients, because they say reimbursement rates are too low or they can’t handle the additional clientele.
Covered California said it is investigating the complaints. The agency’s Dana Howard told KPIX 5: “If we do find that there is a preponderance of misinformation that is taking place,” the insurers will be held accountable.
But California’s insurance regulator, the Department of Managed Health Care (DMHC), said that could be an empty threat because inaccurate lists are not illegal. So far, DMHC said it has received about 350 complaints about Covered California insurance plans since the beginning of the year. Most of them from Anthem Blue Cross and Blue Shield customers.
Both Anthem Blue Cross and Blue Shield said the complaints make up a fraction of a percent of their enrollees. Anthem also said it continues to increase the accuracy of its database. (Full statements below)
Consumers who find their doctor was mistakenly listed at the time they enrolled, should call their insurer and ask it to make good on its promise.
If the insurer refuses, appeal the decision and file a complaint with the department of managed health care at http://www.dmhc.ca.gov/
The more complaints it gets, the more likely DMHC is to take action. Consumers can also email ConsumerWatch at: email@example.com
Anthem Blue Cross has made great progress in increasing the accuracy of the provider database and will continue to make improvements. Members who are having issues finding an in-network provider or who have questions about out of pocket expenses incurred should contact Anthem Blue Cross customer service for assistance.
It’s important to note that the two insurers with the largest enrollments correspond with those who have members contacting DMHC. We are working closely with DMHC to resolve each member’s individual issues as quickly as possible.
Blue Shield Statement:
The number of complaints is accurate, but offers very little value out-of-context. More than 140,000 Californians selected Blue Shield plans as of December 31 meaning the 140 figure is a fraction of a percent of total enrollees. The high volumes have been challenging for Blue Shield and other plans, but we think it’s a good thing that so many Californians are purchasing health insurance through the exchange and we are working to address the backlog.