Health insurers offering plans through Covered California likely will continue to have narrow physician networks during the state health insurance exchange’s second open enrollment period, according to an analysis by the Los Angeles Times.
Background
More than 170 complaints have been filed against Anthem Blue Cross over the insurer’s narrow provider networks, while 130 complaints have been filed against Blue Shield of California over the issue.
No complaints have been filed against Kaiser Permanente, likely because the insurer’s plans include all of its in-house physicians, according to the Times (Terhune et al., Los Angeles Times, 9/28).
In addition, Consumer Watchdog filed two lawsuits against Anthem Blue Cross and Blue Shield of California alleging that the insurers misled consumers who enrolled in their health plans about the size their provider networks.
The new lawsuits come after Consumer Watchdog in July filed a similar class-action suit against Anthem Blue Cross alleging that the insurer misled “millions” of consumers who enrolled in its health plans about which physicians and hospitals were included in their provider networks.
The new lawsuits allege that both Cigna and Blue Shield of California:
Delayed giving their customers complete information until it was too late for them to switch coverage;
Offered inadequate provider networks; and
Presented inaccurate lists of participating providers (California Healthline, 9/26).
Details of Narrow Provider Networks
According to the analysis, 75% of licensed physicians in the state have contracted with 10 insurers through Covered California. Altogether, more than 80,000 health care providers will participate in exchange plans in 2015.
However, the Times notes that many of those providers are only available to treat patients in one or two plans.
For next year, some networks have opted to offer more-narrow physician networks, according to the Times.
For example, HealthNet has proposed shutting down its preferred provider organization network and switching to a network with 54% fewer physicians and no coverage for out-of-network care. However, the slimmed-down plan will cost up to 9% more than the PPO coverage, according to the Times. HealthNet said the change was necessary to keep rates affordable.
Meanwhile, Blue Shield of California has proposed a physician network for 2015 that will have up to 4% fewer providers in certain areas, and Anthem Blue Cross plans to maintain its current physician network, according to the Times.
Response From Covered California
Covered California Executive Director Peter Lee said the exchange is monitoring the exchange plans’ networks to ensure that policyholders have adequate access to care.
Lee said, “If it looks too thin, we say you have to add capacity.” However, he added, “But how much do we put our thumb on the scale of saying more is better? More isn’t always better. The days of every doctor in every network are over.”
Covered Calif. Still Lacks Comprehensive Doctor Directory
In related news, Covered California still does not have a comprehensive directory of physicians that are included in each exchange health plan, the Times reports.
Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, said, “It’s been a low priority for insurance companies to maintain these provider directories.”
There is no estimate for when the provider director will be available, and the exchange is telling consumers to contact individual insurers for more information on plan networks, according to the Times (Los Angeles Times, 9/28).
