Covered California Still Struggling With Doctor-Access Issues

Covered California continues to struggle with problems involving patient access. As the health exchange prepares for its second open enrollment, it is redoubling efforts to ensure that health plans provide accurate doctor lists and sign up enough health-care professionals to see patients in a timely way.

Anne Price, director of plan management for the exchange, told Covered California board members last week that all health plans must meet standards set by state regulators. And as the agency prepares for open enrollment Nov. 15, efforts are underway to improve information and ensure that consumers who sign up for coverage have access to a provider to care for them.

In the first year of coverage offered through Covered California, some consumers struggled to find doctors in so-called “narrow networks” offered by Anthem Blue Cross and Blue Shield of California.

The agency has received more than 300 complaints from Covered California enrollees who had access problems from Jan. 1 through Aug. 31, Butler said. More than half the complaints — 176 — involve Anthem, followed by 130 at Blue Shield and 17 at Health Net. There have been no complaints at Kaiser.

The California Department of Managed Health Care is studying provider access at the four top health plans in the program and expects to issue reports before open enrollment starts, spokesman Rodger Butler told the Business Journal. The four plans are Anthem Blue Cross, Blue Shield of California, Health Net and Kaiser Permanente.

Covered California executive director Peter Lee said the agency could exclude a health plan that fails to provide adequate access to doctors.

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