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A surprising PPACA exchange provider network probe

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Investigators at the California Department of Managed Health Care tested the provider directories of two major California public exchange plan issuers — and discovered that most of the providers are accepting new exchange plan patients.

The department launched the investigation in response to consumer complaints that many of the providers in the provider networks for the Covered California exchange plans are refusing to take new Covered California patients.

The department had members of its staff call some of the physicians listed in the Web directories for a unit of WellPoint Inc. and for Blue Shield of California.

The department was critical of the insurers and said their directories seem to be violating California provider directory accuracy and update standards. Regulators in California and elsewhere are thinking about beefing up network adequacy standards.

But the department found that about 87 percent of the physicians in the directory for Anthem exchange plans and off-exchange individual plans who could be contacted were willing to take new Covered California patients. About 91 percent of the physicians in the Blue Shield provider network who could be contacted said they were willing to take new Covered California patients.

Some of the office locations were inaccurate. With office contact information errors included, the total number of providers in the directories who were open to taking new patients was about 50 percent to 60 percent, health policy watchers said.

See also: 3 ways PPACA plans fool consumers.

Clarification: An earlier version of this article suggested that more than 85 percent of the providers in the California plan provider directories were available to new patients. Because some entries were out-of-date or erroneous in other ways, the percentage of all of the providers in the directory who were taking new patients is closer to about 60 percent.


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