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Accidental exchange plan providers

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Some California exchange plan doctors say they have no idea how they got into new exchange plan provider networks, and others say they were drafted.

The California Medical Association gives a glimpse of what physicians are thinking about the Covered California qualified health plans in a report on a recent member survey that attracted responses from 2,337 medical practices.

California is running its Patient Protection and Affordable Care Act exchange as a state-based exchange. The exchange included a copy of the CMA survey results in a board meeting packet.

About 50 percent of the doctors participating in the CMA survey said they were in a QHP network, and 21 percent said they were not sure whether they were in a QHP network or not.

Thirty-six percent of the providers said they got into the QHP networks through some kind of voluntary, active process.

Thirty-seven percent said they got into the QHP game when a network they were already doing business with automatically opted them into QHP networks under the same terms that apply to their base commercial plan contracts.

Fifteen percent said commercial plan networks automatically opted them into the QHP networks under different terms.

Nineteen percent still don’t why they’re in QHP networks.

About half of the doctors who refused to join QHP networks said they thought participating in QHP networks would involve too much bureaucracy, and 74 percent said the QHP network pay levels were unacceptable.

About 40 percent of the doctors who participated in the survey said they lost relationships with more than 10 patients due to QHP network-related confusion.

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