Finding a doctor who takes Obamacare coverage could be just as frustrating for Californians in 2015 as the health-law expansion enters its second year.
The state’s largest health insurers are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more, according to a Times analysis of company data. And the state’s insurance exchange, Covered California, still has no comprehensive directory to help consumers match doctors with health plans.
This comes as insurers prepare to enroll hundreds of thousands of new patients this fall and get 1.2 million Californians to renew their policies under the Affordable Care Act.
Even as California’s enrollment grows, many patients continue to complain about being offered fewer choices of doctors and having no easy way to find the ones that are available.
Mary Edwards, a 63-year-old librarian in Mar Vista, was excited about a Health Net PPO she picked out last fall because it offered a wide selection of doctors at a reasonable price. But it turned out that several physicians listed on her plan didn’t accept the insurance or weren’t taking new patients.
“This is part of the Affordable Care Act that doesn’t quite work yet,” Edwards said. “This game of who’s in and who’s out is tiresome.”
More than 80,000 medical providers are participating in Covered California next year, according to a Times analysis of health plan information. The data, current through August, were submitted to state regulators and obtained under the Public Records Act.
Altogether, the 10 insurers in Covered California have contracted with an estimated 75% of California’s licensed physicians, or nearly 90% of those considered active in the state. However, many of those doctors are available in just one or two health plans.
All of these insurance networks for individual policies are subject to change and regulatory review before taking effect Jan. 1. The next open enrollment under the Affordable Care Act runs Nov. 15 to Feb. 15.
Anthem Blue Cross, Blue Shield of California, Health Net and Kaiser Permanente dominated the first year of Obamacare enrollment in California, accounting for 94% of the individual market.
Health Net has proposed the most dramatic change for 2015, the data show. It’s dumping the PPO network that Edwards and others purchased and switching to a plan with 54% fewer doctors and no out-of-network coverage, state data show.
It’s been a low priority for insurance companies to maintain these provider directories, and states really aren’t pushing back on narrow networks.
– Sabrina Corlette, research professor, Georgetown University Center on Health Insurance Reforms
Yet premiums for that stripped-down policy are going up as much as 9% compared with pricing for the PPO. State regulators have questioned the company’s moves.
Health Net said its cutbacks were necessary to avoid even steeper rate hikes and it’s confident the smaller network will be sufficient. Its separate HMO network is unchanged for 2015 after about 4,000 doctors were added this year.
The insurer is following the lead of its two rivals Anthem and Blue Shield, which opened last year with sharply limited networks.
