|By Tom Kisken, Ventura County Star, Calif.|
|McClatchy-Tribune Information Services|
Her primary care doctor opted not to accept the plan, she said. Instead of a
The math led her to the next decision.
"I said 'I have to find another doctor,'" she said.
It means some patients end up paying for appointments in cash and asking for reimbursement from their insurance companies.
Or they try to find new doctors.
Before she bought her
"She said 'We can't live on
The Hollisters said they were asked to pay and were given a form to send to
Confusion over physician coverage was a constant during a six-month enrollment period that saw nearly 1.4 million state residents sign up for plans through Covered California. An online tool designed to help consumers find doctors covered by specific plans was removed from Covered California's website because of inaccuracies.
Coverage confusion is magnified in
Both companies offered smaller doctor networks in individual and family policies compared to some of their plans outside of the exchange, she said.
Some private practice doctors say they don't know if they're part of networks or not.
"Physicians aren't getting a clear message," said
Insurers said they're addressing problems by notifying doctors who are participating in their networks. Anthem
"A lot of the confusion has been strained out," Ng said, refuting the implication that Anthem's network of doctors is dwindling. Nearly 2,000 doctors have been added to the plans linked to Covered California so far this year.
Many doctors who received letters from Anthem saying they were incorrectly listed as participating in a plan later signed up to the network, Ng said.
The rate cut is a big reason some doctors are opting out.
"They basically wanted to cut our fees by 30 percent to see patients," said Dr.
Brackett retains hope insurers will expand their networks once they're convinced the Covered California plans are profitable.
As it stands now, people can likely still see doctors who are out-of-network. But they may face increased out-of-pocket payments.
Some doctors work out deals with their patients. Others ask for cash up front and instruct patients to seek partial reimbursement from the insurance company. Some safety net clinics that accept all comers expect their patient numbers to increase.
"I didn't think I could run an office on the rates they offered. I would have declined," said the
The 59-year-old Simi resident considered a half-dozen different doctors. Three doctors said they were incorrectly listed in Anthem's network. Another wasn't taking new patients. Two doctors' phone numbers listed on Anthem's site were disconnected.
She's still looking.
"They're promising you all these doctors," she said, "and it's not true."
People scrambling to figure out if their doctors are covered, should check their insurance company's website. They should also call their doctors.
Blue Shield of
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