California Decides Accurate Health Provider Directories Might Be a Good Idea

Wednesday, October 14, 2015

It seems like an essential part of medical care should be access to doctors and hospital. And now, after a couple of years of Covered California, state lawmakers agree.

Governor Brown has signed Senate Bill 137, which requires insurance companies to provide accurate directories of doctors and hospitals participating in the state’s version of Obamacare. More than 2 million people have chosen their providers through Covered California without any reliable source of what is available to them in their area.

The new law will require the Department of Managed Health Care and the Department of Insurance to develop uniform standards for directories and weekly updates by next July. That will be too late for open enrollment beginning November 1.

A report (pdf) from the State Auditor in June found Medi-Cal patients enrolled by Anthem Blue Cross, Health Net and Partnership Health Plan through Covered California struggled with error-filled directories that incorrectly listed addresses, phone numbers and availability.

In order to save money, insurers limit the number of providers in narrow networks, which reduces the number of options available to patients and obscures the names of participants. One of the dangers, aside from not being able to find a doctor or hospital in one’s area, is using the services of one that isn’t really in a patient’s network.

The new law requires insurers to reimburse patients who inadvertently end up paying for out-of-network services because of bad information. The law also punishes providers that don’t give insurers information on their network status.

Obamacare is not single-payer, Medicare-for-all, insurance. It’s a marketplace driven by consumer choice, which doesn’t work very well without information about provider networks.   

“Doc shock” has been an issue with Covered California from day one. The insurance exchange was late to post its first directory when it opened in 2013. Shortly after the directory was posted, it was declared a worthless mess and taken down. After a lengthy delay, a new, improved list was posted for a short while. But it was also killed for the same reason with no assurance a correct one would ever by produced.

People were signing up with specific insurance companies with the understanding that their doctors were in the network. Way too often, they were not. The dirty little secret of the Affordable Care Act is that those using the health exchange, presumably to receive a premium subsidy, have far fewer choices than those who deal directly with an insurance provider.

That isn’t going to change. The networks will remain narrow, but hopefully by next July, they will be knowable.

–Ken Broder


To Learn More:

California Bill That Requires Accurate Health Provider Directories Signed into Law (by Susan Abram, Los Angeles Daily News)

New Law Aims to Fix a Major Frustration with Health Care in California (by Kathy Robertson, Sacramento Business Journal)

Bill Would Require Insurers to Improve Provider Network Lists (California Healthline)

California’s Obamacare Networks Are Fourth Narrowest in the Nation (by Ken Broder, AllGov California)

Leave a comment