Contract negotiations are about to begin for health insurance companies that want to sell plans next year through the state marketplace, Covered California. One area of scrutiny by the agency is sure to be adequacy of provider networks offered by insurers.
Last year, in order to keep premium costs down, insurance companies sold plans with a narrowed list of doctors for customers to choose from. The goal was to offer doctors and other providers more patients in exchange for a lower cost of providing services.
But many more people signed up for Covered California plans than had been anticipated, leaving perhaps too few doctors to see the patients. Many people scrambled to find a doctor. Complaints to the state show that some people were forced to leave a trusted specialist; some women in their third trimester of pregnancy found they’d have to switch to an unknown obstetrician for their birth.
"It’s unfair and unrealistic," said Betsy Imholz, an advocate with Consumers' Union.
She says Alameda County was a hotspot for problems. Some plans forbid people who live in Oakland from seeing doctors across the bridge in San Francisco. And plans did a poor job of pointing this out to consumers before they signed on. "It’s too rigid, and it’s so far from consumers’ expectations and experience," she said.
Covered California will be negotiating next year’s contracts with insurers over the next several weeks, and health advocates are urging officials to bargain hard on behalf of consumers to expand networks.
At Covered California's monthly board of directors meeting on Thursday, executive director Peter Lee said the agency was already helping to resolve complaints -- including many of the women told they had to change obstetricians. The agency has also asked insurers to expand their networks of doctors.
"We’re doing very active monitoring and in particular in coordination with the Department of Managed Health Care to investigate and assure that plans' networks are adequate," he said.