<p>So, was Covered California the list poster or was it the insurance company ? That’s a real question, btw. Because it seems that Covered California posted the lists after getting them from insurance companies some time ago. They were probably reasonably accurate lists at the time. </p>
<p>I had a link about this, but time passed. CovCa supposedly got the lists from the carriers. Supposedly, (at least initially,) you could still see provider lists via the individual plans.</p>
<p>Yes, complain to the commissioner. CA is a big state and could wrangle many voices. Rather than onesie-twosie anecdotes, there could be a big hubbub. Has there been?</p>
<p>Covered California has to have gotten the lists from the insurers. The insurers are the only ones who could possibly supply that information. Covered California itself doesn’t negotiate with any doctors.</p>
<p>That’s why I blame the insurers. They are lazy and cavalier about supplying accurate information to their customers and potential customers. I’m sure they are violating numerous laws, and some kind of law enforcement should go after them.</p>
<p>Yeah, it’s complicated. The doctors in these stories are telling people they don’t take Covered California. They are not telling people they don’t take Blue Shield. Meanwhile, people think they’re buying Obamacare. </p>
<p>But the Calif Med Assn does also tell doctors they have a contractual arrangement with the insurers and need to check for accuracy, provide various sorts of updates, etc. </p>
<p>Of course, I can see where a doc specifically dropped the contract and it was still wrong. Take it to the man. I;d like to hear someone here did.</p>
<p>Narrow networks are one thing. Narrow networks that include only one board certified doctor in a populous county like Alameda is quite another. And narrow networks that aren’t fully disclosed is yet another. Who wants to pay higher rates only to be told that the only doctor you can see is not board certified. Who knows how long the wait will be to see that person. </p>
<p>My wife made an appointment for my daughter to see her doctor. My daughter needs a checkup and some forms filled out so she can take part in some athletic classes. Made the appointment today. My daughter is going to see her doctor today. Same day. </p>
<p>That should be newsworthy. Maybe I will be interviewed on tv. I should call my brother. He works in tv news. Maybe he would be interested in the story.</p>
<p>Seeing your doctor the same day as an appointment. No emergency either.
How rare is that? I never see stories like that in the news.</p>
<p>I think it is all because of ACA that my daughter gets same day service. I wonder if the doctor will take my insurance. :)</p>
<p>Are doctors who are not board certified not doctors? AFAIK, you don’t have to be board certified to practice medicine in California. Insurance companies don’t have to provide networks that have board-certified doctors.</p>
<p>But they do have to have networks of adequate size. This particular network may or may not have had a network of adequate size; we don’t know enough to say. It doesn’t matter how populous Alameda County is. It matters how many people are in the particular plan.</p>
<p>Licensure does not mean competency. Board certification means the doctor has passed exams written, oral and sometimes practical judged by their peers that they meet minimum competency standards. Most doctors in this country are board certified. Without board certification some hospitals will not grant privileges. </p>
<p>People buying on Covered California should be told all this information. After all, it’s the government that is forcing them to buy insurance or pay a fine. As it is now, the reality of these plans is not meeting the expectations that were sold to the public. Honesty is better than snake oil.</p>
<p>which insurance company dstark? May be you can be their spokesperson. :D</p>
<p>“AFAIK, you don’t have to be board certified to practice medicine in California.”</p>
<p>Really? How do people know if the doctor is for real?</p>
<p>There is some cherry picking going on in these reports. Alameda county has only three health care providers; the Blue Shield plan there is an EPO, not PPO. Anthem’s coverage networks within the county are also limited – probably the best option for the newly insured in Alameda is Kaiser. But the point is – the situation varies among different regions. </p>
<p>I haven’t heard any of these kind of complaints in my neck of the woods, but I had a very hard time finding a PT pelvic specialist who takes my insurance and I have excellent insurance. I did finally find a center but they weren’t on the recommended list from my doctor. I got lucky that a provider I did call recommended I call them and gave me the number. It turned out they had been on the list but taken off only because they moved their facility and weren’t operating for a bit. They had treated many of my doctor’s patients so I was happy I kept looking for one my insurance accepted. </p>
<p>My question would be “board certified” in what? The article doesn’t mention the specialty that the patient was seeking.</p>
<p>Texaspg – “board certified” is not the same as licensed. All doctors in California need to be licensed by the state medical board – but generally “board certified” refers to a process of private certification through associations geared to specific medical specialties. It’s an extra certification that a doctor can seek, not a mandatory qualification. </p>
<p>The network issue is the only issue left. So TatinG, go for it. I hope the network issue gets a lot of play so people can make informed choices.</p>
<p>If enough people complain, insurance companies will include plans with wider networks. The problem with a for profit insurance industry is if something isnt profitable, the insurance companies have no interest.</p>
<p>As more and more people sign up, some providers will see a market and want to tap it. Some providers may not want to accept lower pay, but if the pay is profitable, some will. </p>
<p>If insurance companies see a profitable market with wider networks, they will offer plans with wider networks.</p>
<p>This is only the first year. After this sign up period, there is going to be another sign up period in just 7 months. 7 months.</p>
<p>The great thing, as LasMa said, is we arent stuck with our plans. We can get sick and change our plans. If we find a plan with a better network we can change our plans.</p>
<p>My wife and I have been talking about changing our insurance company in the November time period.</p>
<p>The more healthy people sign up, the more profitable the health insurance industry will be, the more providers can be paid, and the wider the networks can be. So encourage the healthy to sign up.</p>
<p>If Blue Shield’s network is inadequate, I want to know.</p>
<p>Texaspg, :). I have an Anthem Blue Cross plan. It is not an exchange plan although it is identical to an exchange plan. I will let the readers of this thread know if I have any issues. :)</p>
<p>I know in my region that many doctors refused to take the low reimbursement rates for exchange plans. However, some who refused were offered higher reimbursement rates for 2014 only. So expect the networks to narrow even more next year, particularly if the insurance companies are forced to raise premiums.</p>
<p>To say the insurance companies are entirely responsible for this is specious. None of this would be happening without Obamacare. </p>
<p>Board certified is a higher level of certification, after residency, generally for specialties. We could argue whether those without it are truly “bottom of the barrel,” for heavens sake. How do people know the doc is for real? Check his license, reports of complaints investigated by the local med board. .</p>
<p>“All doctors in California need to be licensed by the state medical board”</p>
<p>That works for me. I am thinking of a Calfornia board certifying them.</p>
<p>
</p>
<p>It’s a county/regional thing. BS has far better coverage than Anthem in my region. In San Francisco, it looks to be roughly equivalent, but the Anthem plan is an EPO vs. a PPO for BS.</p>
<p>It’s also a geographic issue. People who live close to an in-network major hospital or medical center probably will not run into issues finding a doctor – but people who live farther away, and are more likely to look for doctor or group practice in their local neighborhood or community, will probably have a more difficult time. I’ve mentioned that none of the local doctors in my community seem to have opted into the new networks – I’m not really bothered by that, because about 10 years ago my options for a local doctor were -0- — then a younger doctor who had recently completed her residency moved into town and set up shop, and I signed my daughter up as one of her first patients. Now I still see that doctor - but I certainly am not under any illusion as to the doctor’s competency level as compared to more experienced physicians who would be available if I expanded my own range. </p>
<p>But you have to focus on your local needs and the local facilities. Reading about Blue Shield’s network in Alameda county isn’t going to give you helpful information if you live in Marin and are more likely to go to San Francisco than Alameda for out-of-county specialty care. </p>
<p>We can blame the insurance companies when they fall down on their own responsibilities. In particular, we can blame insurance companies and no one else:</p>
<ul>
<li><p>When provider lists are wrong. The provider lists are lists of doctors that have contracts with insurance companies. The insurance company knows which doctors it has contracted with. Notice that the claims departments of insurance companies don’t seem to have any problem with this.</p></li>
<li><p>When they don’t answer their phones.</p></li>
<li><p>When they make it difficult or impossible for people who want to pay their premiums, to pay their premiums.</p></li>
<li><p>When their provider networks are inadequately sized, according to the laws governing insurance companies.</p></li>
</ul>
<p>The ACA is the law of the land. Insurance companies are responsible for complying with the law.</p>
<p>In my area, Blue Shield has a way better network than Anthem Blue Cross for the exchange plans. Blue Shield would cover my doctors; the exchange Anthem plans would not. As I’ve mentioned before, my family does not have private insurance, but I was curious and checked out the different plans.</p>