Insurers overstated doctor networks, California regulators charge

[Lakewood90712]

Article about Covered CA Blue Cross and Blue Shield network errors. From the LA Times Top insurers overstated doctor networks, California regulators charge - LA Times

 

[Senator]

It won't be long and all providers will have to take all insurance. That would solve the mess. The government will set the prices, and not the insurance companies.

 

[wolf]

2014, had Covered California, Blue shield.

2015, plan going to Health Net, forget, Covered CA, ACA, obamacare.
still a mess.

One secret no one talks about, copays, coinsurance, and deductibles that have to me paid, before insurance kicks in.

Two good things, max $6K+, out of pocket per year. No pre-existing condition deniel.

 

[rodi]

2014, had Covered California, Blue shield.

2015, plan going to Health Net, forget, Covered CA, ACA, obamacare.
still a mess.

One secret no one talks about, copays, coinsurance, and deductibles that have to me paid, before insurance kicks in.

Two good things, max $6K+, out of pocket per year. No pre-existing condition deniel.

It's been talked about extensively... Not a secret at all. You pay in full till you meet your deductible - then you pay your copay or coinsurance till you meet your OOP max. How is that a secret?
What does deductible mean to you?

 

[timo2]

It won't be long and all providers will have to take all insurance. That would solve the mess. The government will set the prices, and not the insurance companies.

I was thinking it would go the other way: Vertical integration: that the insurance companies would hire their own doctors, and those doctors would only take that particular insurance. Like ar to CVS and Walmart that are putting medical personnel in their stores. [edit: I mean similar to these stores. I don't know what insurances they take]

 

[jj]

The overstating of provider networks is not confined to ACA polices.

We have employer provided retiree insurance and I had this same issue this year. I was looking for an in-network specialist, consulted the online provider directory for my particular network (each insurer has multiple) and found someone, called them to make an appointment and was told they didn't take my insurance. I went back to my insurer, the agent's first assumption is that you can't use their online system so she told me that this Dr did indeed accept it. At which point I almost gave up, but insisted that they go further into their own system to check the provider contract, whereupon the agent told me that it had run out in October of 2011 - but it was still showing in their provider directory almost 3 years later! I submitted a request through the channels provided in their system for them to correct the incorrect provider (twice!) but 6 months later the whole group of doctors is still showing as in-network when I know that they are not.

I believe this is an industry-wide problem and not confined to Obamacare policies. It is important to check with any doctor you plan to use if they really are in-network.