Covered California Enrollees Complain About Limited Doctor Choices Nearby

[Jesus Malverde]

Source: CBS Local

California’s health care exchange promised potential customers they would have enough physicians to choose from. But some new enrollees, including an Alameda County woman, are discovering that their doctor choices are extremely limited.

Julia Turner is surprised that she even has to search for a doctor. When she signed up for a policy through Covered California late last year, her long-time physician was listed as participating in her Blue Shield plan. It turned out; however, that he is not accepting patients with her Blue Shield policy, purchased on the Covered California exchange.

When Turner called around to find someone else to treat her, she got more frustration. “The only doctors accepting new patients are urgent care clinics,” Turner told KPIX 5 ConsumerWatch.

snip

When KPIX 5 contacted all of the 41 doctors on the list Blue Shield provided to Julia, it found only four of the doctors were actually accepting new adult patients, and only one of them was board certified.



Read more: http://sanfrancisco.cbslocal.com/2014/02/19/covered-california-enrollees-complain-about-limited-doctor-choices-nearby/

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[Trillo]

1. The ability to fire a doctor is extremely important.

If you as a patient have no other choices, how can you fire them?

[MsLeopard]

2. In San Diego County

I was surprised to find out that my long time physician was only going to accept one Obamacare plan, and it was BS/BC. I had to pay more than I wanted just to keep my doctor, but I'm willing to do it and am happy to have insurance again.

[Jesus Malverde]

3. I'm glad that is working out for you.

I was curious how much the person in the stories premium was.

I am under the impression that the insurance companies are charging their regular rates.

Seems like they are not providing regular service.

[MsLeopard]

5. I agree

The service has been horrible - I received the first bill three days before it was due. Like they wanted me not to pay, or something. BS/BC gives a ton of money to Rs and I wouldn't be surprised if they are trying to sabotage the law while they make serious money off it. I'm two years away from Medicare and they are getting $746 a month to insure me. It's a joke.

[anasv]

8. bc bs

There as a news article several weeks ago, I forget where to the tune that bc bs was starting up plans in every state. They had decided that ACA was an opportunity for them.

If the doctor choices are that limited, their plan should be de-certified or whatever.

Someone correct me if I'm wrong, but aren't the ACA reimbursement rates equal to Medicare reimbursement rates? I thought they were. Most doctors in my rural New England area take Medicare patients. Maybe things are different in California?

[ramapo]

4. Need to regulate the insurance companies

The ACA does not have nearly the requirements and oversights needed to police the insurance companies. Here in NJ, almost all available policies are very limited EPO or HMO networks. Companies are not required to offer a PPO. I don't think there is anything that ensures that a network provides reasonable choice except for some vague distance limits.

[JDPriestly]

7. Insurance companies are regulated in California.

We directly elect the insuurance commissioner.

[JDPriestly]

6. Sounds like a dearth of doctors.

The narrowest networks – those with the fewest doctors – are in some of the Northern California counties with the lowest median household income and the highest number of Medi-Cal recipients. Alameda County falls into that category.

One insurer told KPIX 5 that so many doctors in Alameda County initially declined to accept the low reimbursement rates, the insurer couldn’t get enough doctors to meet the state’s minimum network adequacy requirements.

So the insurer came back and offered similar reimbursements to a much narrower network of doctors. Those doctors agreed to the rates in exchange for the insurer limiting patient provider options, and funneling more patients to fewer doctors.

Read more: http://sanfrancisco.cbslocal.com/2014/02/19/covered-california-enrollees-complain-about-limited-doctor-choices-nearby/

First, this news source does not seem to have much positive to say about the ACA at all. Also, I wonder whether these doctors are willing to accept new Medicare patients. Medicare also does not pay a high reimbursement rate. So that is a question that should be asked and apparently was not asked by the reporter. Sounds more like a shortage of doctors than any problem with the ACA. If the doctors needed more patients they would deal with the reimbursement rate.

In Los Angeles, there are doctors who will not accept Medicare patients I have been told.
I go to Kaiser and they accept Medicare but recently I had difficulty getting a refill on a medication. The medication is expensive. Medicare limits the amount the doctor can prescribe on Medicare. If you need more than that (and I do. It's just an oil not anything registered as a dangerous or addictive substance), you have to pay for it yourself. $200 for a not very large bottle.

So the ACA is probably treated the same as Medicare. That is my guess. That area might need to set up a special sort of care facility like the ones Bernie Sanders provided for in the bill.

On edit:

http://www.democraticunderground.com/1014733272

That thread discusses the fact that California has already exceeded its enrollment goals in the ACA. If enrollment continues to snowball, doctors will find more and more of their patients are coming in with ACA policies and will have to find a way to organize themselves to serve their patients or go out of business. Some of the doctors may not be very efficient.

[anasv]

9. "Medicare limits the amount the doctor can prescribe on Medicare."

"Medicare limits the amount the doctor can prescribe on Medicare."

I have not seen that at all. I have AARP Medicare Plan D, and every month they fork out about $400 for one prescription and about $300 for another prescription for me, not to mention lower amounts for 2-3 other ones. Both of the higher cost prescriptions required pre-authorization, which came through in, count it, one day, for ten years.

I had to take a specialized rare antibiotic last year, $800 for two weeks worth, which got approved in a few hours.

If I were you, I'd phone your Plan D people directly and ask about this oil. It may be that your doctor's office has screwed up.

[Freddie Stubbs]

10. This is one of the ways in which health care costs are being driven down

[Jesus Malverde]

11. tradeoff

One insurer told KPIX 5 that so many doctors in Alameda County initially declined to accept the low reimbursement rates, the insurer couldn’t get enough doctors to meet the state’s minimum network adequacy requirements.

So the insurer came back and offered similar reimbursements to a much narrower network of doctors. Those doctors agreed to the rates in exchange for the insurer limiting patient provider options, and funneling more patients to fewer doctors.

Pat Johnston of the California Association of Health Plans, the industry group representing the insurers, admits there some issues with doctor availability. Johnston calls it a “tradeoff.”