<p>An article out of Chico, California with a better explanation as to why doctors aren’t taking Covered California. One insurer, Anthem Blue Cross, refused to provide the pediatricians group with their reimbursement rates, so the doctors refused to contract with them. </p>
<p>And overall, reimbursement rates under ACA are lower. </p>
<p>Flossy and TatinG, you still haven’t explained to us what “not taking Covered California” means. In the article from Chico that you linked, we find the doctor they interviewed, Elisa Brown, says her practice accepts Blue Shield policies sold on the exchange, but not Anthem Blue Cross policies sold on the exchange. </p>
<p>I don’t dispute that Anthem has been incompetent at having up to date provider lists (and everything else involving customer service). But the doctors interviewed in the article take some plans on the exchange, and don’t take others. Your assertion that doctors “don’t take Covered California” is not supported by the Chico article you linked.</p>
<p>I dont know. The insurance companies should have a list of doctors that are signed up in their plans. There should be a list of doctors practicing in California. It shouldnt be so hard to figure out a percentage. </p>
<p>Insurance companies and doctors should come to some agreement on whether the doctors are signed up or not. </p>
<p>This will happen. If patients have doctors that are not in their network, they wont be happy.</p>
<p>Did you actually read the article, Flossy? The whole thing?</p>
<p>The article interviews Dr. Elisa Brown of North Valley Pediatric Associates. She is the only representative of any medical practice interviewed for this article. She says that her practice does not accept the Anthem Blue Cross policies sold on the exchanges because they don’t like the reimbursement rate. However, the practice does accept Blue Shield policies sold on the exchange:</p>
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<p>In other words, the practice accepts some plans sold on the Covered California exchange, and doesn’t accept other plans sold on the exchange. It makes no sense to say her practice “doesn’t accept Covered California”. </p>
<p>You represent that someone who buys a policy on the exchange can’t get that policy accepted by North Valley Pediatric Associates. That is untrue. If the parent of a patient of Dr. Brown wants to buy insurance from the exchange and still have their child seen by Dr. Brown, they should get a Blue Shield exchange policy. </p>
<p>I’m not even understanding this line of attack as to logic. Do you imagine that pre-ACA, every practice accepted every insurance plan?</p>
<p>“That article was wrong,” says Molly Weedn, spokeswoman for the CMA. “We have no idea how many doctors are participating. We don’t collect that data.”</p>
<p>"The CMA says Pollock offered his estimate of 70% nonparticipation to Thorp, the CMA president, who responded that it “wouldn’t surprise” him.</p>
<p>That was an error on Thorp’s part; since his own organization doesn’t have its own estimate, he should have kept his mouth shut."</p>
<p>Just a diversion.<br>
By “affected” I did mean manipulated.
All of us need to be careful to vet.
The pediatrician tale perks one up- but there is no description, for us to weigh.</p>
<p>Btw, CMA advised its doc members to check their own listing and details in the insurer info and initiate corrections. The doc-insurer relationship is apparently contractual. One could say, if docs move out of state (as quoted in some link,) they should inform the insurer they are no longer standing under the umbrella.</p>
<p>We can add Kaisers doctors to the doctors with Anthem and get a minimum percentage of doctors included in covered cal plans. The actual percentage will be higher than the minimum because there will be doctors in Blue Shield plans and Health Net plans that are not in Anthem’s network and need to be included. </p>
<p>I hope this is clear. So we need to know how many doctors are in Anthem’s network. I am using Anthem because they have the largest network. That info is out there .</p>
<p>Someone with lots of time on their hands, could go down the list of the tens of thousands of doctors, call each one and see who is in and who is out. The insurance companies lists of providers isn’t accurate. </p>
<p>But it shouldn’t come as any surprise that there are doctors who don’t choose to participate if the reimbursement rate is lower. </p>
<p>Geez, all I did was link an article. I am fascinated by the discounting of anything ACA negative. There are negatives. Yesterday was a very bad day for the ACA. It just was. A fact. </p>
<p>We can agree there will be inaccuracies. And sure, some will choose to opt out based on rates. And, it’s not hard to find comments that it has long been this way. ACA didn’t mandate lists that include errors. There “should” be accurate lists. </p>
<p>Flossy: funny thing: if we could get past linking incomplete media reports, you very well might find a much more open discussion of some issues many of us are annoyed by. Instead it’s “link and rebut.” </p>
<p>(Corrected “liking” to “linking.” Tho it is also an issue of liking.)</p>
<p>The thing is that the lower reimbursement rates incentivize doctors to opt out of participating,. ACA did nothing to lower the cost of health care,for example, lowering expenses for the providers, ie. malpractice insurance.</p>
<p>Good grief LF, I linked it because what it said was being questioned. The Riverside doctor is quoted as saying his practice is not accepting exchange insurance because of the low reimbursements. There’s nothing to rebut. </p>
<p>Tatin, we need some economic theory here, probably Econ 101; if they opt out of a large pool, where is their patient stream to come from?<br>
Malpractice insurance is a left field insert, here.</p>
<p>Another way to figure out how many doctors are in network is to divide California into areas or regions and take the insurance companies that cover the most doctors in every region and add up those doctors. </p>
<p>That is done in a small way in the prior link. We wont get an exact percentage but we will get one that is close.</p>
<p>Flossy, it was the general “we.” But yes, I include you. 300,000 patients and the article says: “Larson wasn’t sure how many of the clinics’ patients would be affected.” I’m supposed to accept that they made a decision to decline without knowing how it touches bottom line-? </p>
<p>I had the pediatrician article in mind. *Dr. Kathleen Sullivan and Dr. Elisa Brown of North Valley Pediatric Associates said the Redamonti family was one of several existing patients their office had to tell they are not accepting their new health insurance. * Several-?? Doesn’t inform me much.</p>
<p>And I could have learned more if that article told me about the interaction with the insurer that led to “the company refused to provide the practice with reimbursement rates and the spectrum of care that was covered.” </p>
<p>I wanted to find out the average malpractice premium for doctors. Google is NOT helping me here. I got the following headers, all from the 2011-12 timeframe:</p>
<p>LF - Were you that nit-picky with pro-ACA articles? Because I seem to recall a lot of news stories filled with glowing health care reform promises that are now being refuted by reporters who sometimes seem genuinely shocked to learn that some of these not so great things are happening. The Riverside story in particular was very thorough and used a number of sources. I guess you can decide not to believe the doctor but the reporter doesn’t get to do that. Reporters report.</p>
<p>I wouldn’t call them hit pieces. This is the other side of the story. </p>