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Exchange plans worry California docs

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Dr. Mark Dressner says California’s public exchange need to act now to keep physicians in the networks.

Dressner, president of the California Academy of Family Physicians, said doctors who treat Covered California exchange plan patients feel confused, frustrated and poorly paid.

“We have never received such an outpouring of complaints about plans’ contracting strategies,” Dressner writes in a letter included in a Covered California board meeting packet.

Members of the Covered California board met in Sacramento today.

The state-based exchange has faced some Web glitches, but the carriers selling qualified health plans through the exchange already have attracted about 1 million enrollees.

Many of the enrollees already are using plan coverage to see doctors.

Doctors say plan reimbursement rates are 20 percent to 40 percent lower than traditional plan rates.

“Our physicians describe these payment reductions as unaffordable to their practices,” Dressner says.

In some cases, Dressner says, carriers seem to think they can change contract terms by simply sending letters to the physicians.

Physicians have trouble finding out what the plan contract terms are, or even finding out whether they’re really in a plan provider network, Dressner says.

Dressner says his group is telling physicians they have to negotiate terms with the plan issuers just as they would with any other private payers.

During a public comment period at the board meeting:

  • A California Association of Health Underwriters representative said the exchange needs to develop a system unhappy enrollees can use to switch from one plan to another.
  • A consumer group rep said Covered California should keep enough call center staff on hand to help the many consumers affected by payments system glitches and other glitches.
  • A consumer group rep asked the exchange to post a guide for the consumers who will be trying to qualify for “special enrollment periods” for individual plan coverage between March 31, when the 2014 open enrollment period ends, and Nov. 15, when the 2015 open enrollment period is tentative scheduled to begin.

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