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Old 08-20-2016, 04:12 PM   #61
Dryer sheet wannabe
Join Date: Feb 2014
Posts: 22
In SoCal, Covered California offers 2 different PPO networks, Anthem and Blue Shield. Originally when Blue Shield started offering CoveredCa plans, they went to their doctor network and said if you want to be included in our CoveredCA network, we are cutting your reimbursement 30% for all of our plans. Many private physicians opted out of the Blue Shield network. This caused a lot of issues with access. Over the last 2 years, Blue Shield has expanded their network, but it is still smaller/narrower than the one offered to their group plans. Nonetheless, the major research hospitals are all included and the network actually is pretty good now.
Anthem had the broader network originally. However, they started narrowing their network in the last couple of years and there are now a number of specialists who previously took Anthem CoveredCa plans who no longer do. Also, Anthem has proposed a major rate hike for 2017.
Thus, it looks like I'll be switching from Anthem to Blue Shield for PPO access next year.
I've tried to get actual data on the breadth of Anthem vs. Blue Shield's network, but have been unable to find it. They both say to check individual doctors using their tools. I've had a dermatologist and neurologist drop out of Anthem since we enrolled, but good alternatives have been available. Also no problem seeing a world class specialist at UCLA.
If you are willing to sacrifice physician choice and want a HMO, Kaiser is clearly the best in SoCal. However, you will need a good advocate to get you the treatment you want/need in a timely manner. Great specialists available at Kaiser Sunset, but you need to navigate the system. There is a tendency to just stabilize and get rid of the patient as opposed to finding the underlying cause and treating it.
All anecdotal experiences.

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