California doctors say inaccurate private exchange plan provider directories cause serious problems for them and their patients.
Kim Griffin, chair of Medical Office Managers of the Peninsula, talks about the problems in a letter she sent to the Covered California board Tuesday.
The state-based exchange says 728,410 residents had picked qualified health plans by Jan. 31.
Many of the plan buyers are getting their coverage from the same carriers that dominate California’s individual and small-group markets.
But, with the exception of one carrier, Health Net, most of the bigger players are paying providers lower fees to care for plan enrollees than others, Griffin writes.
In northern California, “many of us have opted out of the products due to poor reimbursements,” Griffin writes.
But, in many cases, carriers seem to be including practices that have opted out of the networks in the plan provider directories, Griffin writes.
Covered California and the plan carriers issuers, have in effect, created a “silent preferred provider organization” – the kind of disreputable entity state regulators have traditionally tried to curb, Griffin writes.
Practices spend time and money to discover patients receiving in-network care were really out-of-network.
The administrative costs for the accidental out-of-network patients are sky-high, and then, once the practice tries to bill them, the patients may pay little or nothing for the care, Griffin writes.
Griffin says Covered California should let practices bill the plans for the accidental out-of-network patients at non-contracted rates.
“Covered California in conjunction with the insurance companies should accept responsibility and make each practice whole,” Griffin says.