Friday, December 20, 2013

Finding Health Plans that Include Your Doctors

Shopping for doctors isn't always easy. CoveredCa, California's health exchange seems to be making it tougher. Ask someone looking for a doctor.Many individuals are looking to use Covered California to get a policy that lets him keep a handful of doctors they like. But like many applying for coverage, the choices are not always to their liking. "My internist is not on the plan",individuals say. Neither is my orthopedist or any of the specialists recommended the individuals primary care doctor. As a result, many are having a difficult choice to make: Keep looking for an affordable plan with the doctors they like, pick a plan with new doctors, or sign up for a plan that allows care by out-of-network docs, typically at a higher cost. Many consumers who currently have insurance and are shopping for a new plan through Covered California are finding it difficult to locate policies that include the doctors and hospitals they're accustomed to seeing. Insurance brokers aren't finding the process any easier. Three words: It's a nightmare, says insurance agents. Most of the insurance companies on the exchange are offering provider networks that are far narrower than the other plans they're selling outside of the exchange. Just how much narrower, however, isn't clear. It is hard to determine. Covered California issued a report last week saying that more than 58,000 physicians were available through the exchange's plans, compared with the 63,000 to 72,000 physicians in the state's largest commercial networks. But how that plays out for consumers probably depends on the specific plan they choose. Blue Shield, the San Francisco-based nonprofit insurer, says it is offering a network through its exchange plans that represents roughly 50% of its full network. In many cases, even doctors themselves are unsure of their status in the new plans. Insurers have a long history of inaccurate and outdated provider listings, which the law does nothing to fix. And the provider lists found on Covered California have themselves been riddled with errors. There are quite a few inaccuracies. The changing and shrinking provider networks do pose a challenge for consumers, but then again that's nothing new. Even before the Affordable Care Act, networks changed because health plans and physician groups reached different agreements on costs. One of the benefits of the Affordable Care Act may make coverage more expensive. Plans must now provide standard benefits across all of their products. Annual limits on out-of-pocket costs apply, and, of course, they must now accept all comers and cannot charge people with preexisting medical conditions more than the healthy. To make insurance affordable, insurers are seeking to control costs in part by limiting the number of doctors and hospitals included in their networks. The question for consumers, is whether they can locate a plan that has good doctors and hospitals at an affordable price. And that's a question that many people are wrestling with for the last couple of months. Most individuals are concerned with how do I decide if I continue to see my primary care physician? Consumers shoudl be to go to any doctor they want. Unfortunately that's not the case. Experts offer some tips for consumers in the market for a plan that includes the doctors they wish to see. Do your homework. Check directly with both your health plan and your doctors and hospitals, particularly if your choice of policies is based on keeping the doctors you like. Unfortunately, you'll need to check each plan's network individually for your doctor. But, beware; Even if your doctors of choice are listed as participating with your plan, be sure to inquire as to whether the office is taking on new patients. Don't be afraid to switch plans. Open enrollment runs through the end of March. If you're unhappy with the plan you purchased early in the year, or learn that you don't have access to the doctors you thought you did, you can switch to another plan before March 31, 2014. Enlist the help of an insurance agent. Local insurance agents certified to sell you a health plan through Covered California can be invaluable. For some reason there is a misconception that if you use an agent you'll have to pay. It costs you nothing extra to have a certified insurance agent who can help you with the decision.Once you're signed up, an agent often works as your advocate when problems with your insurance plan arise. Finding the right plan has been frustrating for many, but keep a sense of humor. As one individual says "Right now I'm starting to look to see if there's a psychologist in the network, because I'm going nuts".

Tuesday, November 19, 2013

Doctor Networks Supporting ACA Compliant Plans

Health coverage is only as good as the doctors who accept it, an important truth when buying a policy from Covered California, the state’s new medical marketplace or an insurance carrier directly.

The doctor networks supporting plans in CoveredCa (new health exchange) which is the place for uninsured Californians to purchase subsidized policies, as well as carriers directly are getting more attention as individuals compare and consider offerings from different insurance companies.

While the policies listed on the new exchange each have a price clearly displayed, finding out which doctors are included can take a bit more digging. Big providers like Sharp HealthCare and Kaiser Permanente each offer their own plans backed by their own doctor networks. In other cases, the connection between insurance companies and providers is not as obvious.

Carriers like Anthem Blue Cross, Blue Shield of California and HealthNet have worked their own deals with local doctor and hospital providers to back the plans they offer on and off the exchange. Anthem has partnered with UC San Diego as its top-tier provider, while Blue Shield has selected Scripps Health.

Executives with in each health care system say they agreed to take less reimbursement dollars from insurers in hopes that the exchange would deliver a healthy new volume of patients. Paul Viviano, chief executive of UC San Diego Health System, said he believes the university can work with Blue Cross to keep patient costs low.

“Lower cost was the the focus of our conversation. We felt that we could develop a product that was useful and attractive,” Viviano said.

Likewise, Scripps CEO Chris Van Gorder said his organization decided that it was important to participate in the exchange even if it meant taking lower reimbursement than previously offered.

“I’'d be surprised if anybody didn'’t discount their rates,” he said. “We assume we are going to get volume in return, but we didn'’t negotiate any guarantees. We just believed we had a community obligation to participate.” Neither executive would disclose how much their organizations agreed to discount services in order to cement a deal with their exchange insurance provider.

These partnerships have created fewer doctors and narrower lists of participation in some, if not most plans than currently exist for individual policies that have been available from the same carriers prior to 1/1/14.

There are about 2,233 doctors supporting Blue Shield of California’s health exchange offerings in San Diego County. That number represents only about 53 percent of Blue Shield’s total affiliated doctor network in the region.Those who buy Blue Shield exchange policies will be able to use 12 of San Diego County’s 20 hospitals. UC San Diego Health System said all of its 820 local doctors are included. Anthem and HealthNet have not released the numbers for its doctors and hospitals. 

This pattern for trading discounts for relationships that could deliver high volumes of patients, does not appear to be unique to San Diego County.  “It is a common for hospitals and doctors to negotiate these types of arrangement where providers hope to gain more volume. But this strategy has not worked so well in San Diego County.

Dr. Ted Mazer, an ear, nose and throat doctor and spokesman for the San Diego County Medical Society, said he did not participate in some Blue Cross plans due to reimbursement rates offered. He said many doctors who work in partnership with the larger health systems in the area do not realize that they have been signed up for exchange plans through their affiliation with that larger partner. Mazer predicted chaos in the provider world when patients start showing up, insurance card in hand. “Most of the doctors don’t know what they’ve got, and they don’t know, really, if they’re in or out,” Mazer said. He added that inaccuracies in Covered California’s online doctor directory also have persisted in some cases, despite attempts to make corrections.

The big question, then, is whether the doctor networks assembled by insurance companies will be adequate to support demand. So far, local providers seem confident that their new patients will be able to get a doctor appointment with their newly purchased policy.

Johnston, the health plan association CEO, said "we expect that people are going to be very happy with the tailored networks set up in each region of California to provide care. Does that mean every doctor and hospital is included? No. The test should not be whether every provider is included but whether consumers have good care, reasonably available,” Johnston said.