Monday, September 29, 2014

California’s Narrowing Physician Networks

Yes, man is broad. Too broad, indeed. I’d have him narrower.

Dostoevski (1821-1881), The Brothers Karamazov

California is a wonderful place to live, if you happen to be an orange.

Fred Allen (1894-1956), American Comedian

If you live in California, home of one of nine Americans, you are likely to have a narrower choice of doctors in 2015 (Chad Terhue, Sandra Poindexter, and Doug Smith, “ObamaCare Networks to Stay Limited in 2015, “LA Times, September 28, 2014).

The state’s largest insurers are narrowing their networks, and the state health care exchange, Covered California, is too. The exchange isn’t even providing a directory to help consumers match their health plans with doctors.

You are on your own when it comes to finding a doctor. This year, 1.2 million Californians will seek to renew thier ObamaCare policies. And 30,000 Golden State residents will face health exchange enrollment delays, or dropped coverage.

Health Net, one of biggest state insurers, is dropping its PPO and switching to a plan with 54% fewer doctors and no out-of-network coverage. Health Net and other major California insurers – Anthem Blue Cross, Blue Shield of California, and Kaiser – insist restricted networks are necessary to avoid steep hikes in premiums.

Covered California, the state health exchange plan, says it will pay doctors less and reward remaining doctors with more patient volume. If doctors lose money with each patient, so be it. Presumably they will make it up with more volume. Covered California has no central doctor directory and refers patients to insurer websites, which are inaccurate about which doctors are in and which doctors are out.

Dozens of individual policyholders are suing Anthem and Blue Shield, saying the plans have misled them about participating doctors. To add to the confusion, many insurers have instituted more restrictive policies, known as EPOs, Exclusive Provider Organizations, which do not cover out-of-network physicians, whose charges consumers must pay.

Insurer customers are unhappy with these arrangements. Blue Shield consumer, Heidi Shertiff, 53, says her gynecologist and her gastroenterologist, are not covered under her new plan. Two new doctors listed in her new plan don’t offer coverage, and a third hasn’t accepted a new patient in three years.

Shertiff asks, “Where was the state in protecting people for these false promises? I’m not getting what I paid for.”

Mary Edwards, 63 from Mar Vista, complains, “This is the part of the Affordable Care Act that doesn’t quite work yet. This game of who’s in and who’s out is tiresome.”

Except health coverage isn’t a game. It’s about your health, and it makes a difference even in California, the state of milk and honey, Apple, Google, Silicon Valley, warm climate, and salubrious life styles.

This tale brings to mind the words of Robert Frost (1874-1963):

I met a Californian who would

Talk California – a state so blessed,

He said, in climate, none had ever

died there

A natural death, and Vigilance Committees

Had had to organize to stock the


And vindicate the state’s humanity.

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