<p>Following up on the article in TatinG’s post, Robert Laszewski who has talked with many insurance companies around the country said the following:</p>
<p>“There is a lot of dissatisfaction being communicated from consumers to insurance company call centers and their agents about the new health insurance plans, particularly compared to the plans people are used to.”</p>
<p>Can you imagine enrolling in a plan because the insurance company’s website indicated your doctor was in the network and then find out he/she is not. The only thing that Covered Ca or the other exchanges around the country cared about were the numbers, not the product they were selling. Ugh. </p>
<p>How many providers are listed overall on Anthem’s list? That is, what fraction of the total do those 965 doctors who were erroneously listed represent?</p>
<p>I think that this is an Anthem problem, not a Covered CA problem. It is the insurer’s responsibility to provide accurate information as to their provider lists. </p>
<p>Some of the biggest doctor groups in Fresno have opted not to participate in plans offered through the state exchange, saying the reimbursement is too low. Health plans counter that they’ve tried to keep costs down and that doctors stand to gain from an expanded patient case load.</p>
<p>Stuck in the middle: Consumers, many of whom have paid large premiums for health plans they thought offered a wider choice of providers. They now must choose between finding new plans or having to find new doctors who are accepting patients covered by Anthem Blue Cross or Blue Shield PPOs.</p>
<p>And it could be difficult finding doctors.</p>
<p>The 160-doctor Central California Faculty Medical Group — one of the largest private physician groups in Fresno — decided not to accept patients with PPO plans through Covered California.</p>
<p>“We would be paying to see patients, and we just couldn’t afford to do that,” said Dr. Karl Van Gundy, a pulmonologist and president of the board of directors for the group, which is affiliated with the University of California at San Francisco-Fresno Medical Education Program.</p>
<p>GP, I guess you’re not aware that CoveredCA didn’t “sell” anything. I agree that the insurers have done a dismal job of posting accurate provider lists, among other things. But that’s on them, not CoveredCA or ACA.</p>
As far as I can tell, the problems are primarily with one company – Anthem (Wellpoint). I have no complaints about BlueShield’s customer service or the accuracy of their provider list - and haven’t seen similar post-ACA complaints about the the other insurers, such as Kaiser or HealthNet.</p>
<p>Agree, calmom. I’ll amend: Anthem has done a dismal job of posting accurate provider lists. That is entirely due to Anthem’s inefficiency, confusion, failure to nail down contracts, or whatever their problem is. Nothing in the law required them to be so bad at it, which GP seems to imply.</p>
<p>Anthem has done a dismal job of posting accurate provider lists, to go along with their dismal job of having enough people to answer their phones, their dismal job being able to answer consumer queries, and their dismal job of billing.</p>
<p>Evidently they are OK in the group market (we have an Anthem group policy and have had no troubles) but they seem to be dedicated to providing abysmal customer service for their individual policyholders, of which there will probably be many fewer next year if word gets around how bad they are.</p>
<p>IMO Anthem is stuck in the past, when they could understaff and provide endlessly horrible customer service because their costumers were trapped. It doesn’t seem to have sunk in that if they treat people like dirt, we can actually leave next year. </p>
<p>Oh please. Blue Shield s*cks in my region. Their provider network is awful and the customer service is equally bad. Try calling them to see how long you will have to wait for an agent; plus their agents are equally clueless about who is covered. </p>
<p>Don’t tell me Covered Ca is entirely blameless with what is going on right now. The only reason why we have this mess is because of a very flawed law. </p>
<p>This quote by the office manager of the provider group in the article posted by Tatin is very telling:</p>
<p>“Patients are not aware that they’re paying more money and they have a limited network now, a limited formulary and less benefits”</p>
<p>BTW, I called my urologist in Jan to make an appt and was told by the office manager they do not accept non-grandfathered Blue Shield or Anthem individual plans. This doctor is listed on both companies’ websites.</p>
<p>GP, insurers don’t need a law to help them screw up. I am insured through employment, and no reason to use the exchanges. I needed to find a specialist through Aetna. The choice was abysmal, but I found one in my geographic radius who looked possible. When I called to make an appointment, I found out he’d been dead for two years. </p>
<p>Yep, hayden. I guess some will believe that anything and everything that goes wrong with doctors or insurance is automatically the fault of ACA. But i have personal experience of Anthem screw ups which were happening long long before Obamacare came into existence. </p>
<p>Compare the network for a grandfathered Anthem or Blue Shield plan and an Obamacare (individual) plan sold on and off the exchange. Oops, I forgot - you can’t do that right now. But if you could, you would be shocked how different it is.</p>
<p>Seems like the local papers are covering the problems in their area. No paper that I’ve found has determined the number of doctors accepting the Covered California plans with statewide numbers or percentages. But clearly it’s a problem. Since most people are covered by employer plans the doctors have plenty of business and have no need to accept the low reimbursements on the ACA plans. </p>
<p>I noticed that close to 70% of the people on the exchanges are signing up for silver plans. These plans have deductibles of $2,500. Of course, something like 90% of these people are receiving subsidies. What I would love to know is how many of the unsubsidized people off the exchanges are signing up for silver plans. My hunch is that the overwhelming majority cannot afford them and are taking the bronze plans ($5,000 deductibles) instead. Just another way the unsubsidized are getting screwed under this new law.</p>
<p>The subsidized are getting subsidies because they’re poor. If you think getting a subsidy is such a great thing, you need only give up a big chunk of your income. </p>