Narrow Networks


Anthem Blue Cross Sued Over Covered California Doctor Networks

The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images)

The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images)

By Julie Appleby, Kaiser Health News

Statewide insurance giant Anthem Blue Cross misled “millions of enrollees” about whether their doctors and hospitals were participating in its new plans, and failed to disclose that many policies wouldn’t cover care outside its approved network, according to a class action lawsuit filed Tuesday.

As a result, many consumers are on the hook for thousands in medical bills, advocacy group says.

As a result, many consumers have been left on the hook for thousands of dollars in medical bills, and have been unable to see their longtime doctors, alleges the suit by Consumer Watchdog based in Santa Monica.

Anthem spokesman Darrel Ng declined to comment directly on the lawsuit. He said Anthem has agreed to pay the claims of those who received treatment from inaccurately listed doctors during the first three months of the year.

However, that policy would not be extended for enrollees who discovered after March 31 that their doctors had been incorrectly listed, he said. Continue reading

Some Covered California Plans Narrow Your Choice of Doctors, Hospitals

(Joe Raedle/Getty Images)

(Joe Raedle/Getty Images)

By Pauline Bartolone, Kaiser Health News

When Diane Shore got a letter that her health policy would be canceled, the small premium increase for a new plan didn’t bother her that much. What she’s really troubled by is: “My physicians will no longer be in this network of physicians, or the hospitals won’t be as well.”

“There isn’t something that says: ‘Alert. Be aware. Take action now to be sure this works for you.”

Sixty-two year old Shore owned an IT consulting business in the San Francisco Bay Area, and retired when she sold her business in 2000. She says she wants to stick with the providers that she’s had for years, including the surgeon who operated on her for breast cancer in 1998.

“I have full confidence in her,” she says. “And my primary care doctor has been my primary care doctor for 20 years.”

In Shore’s case, the problem is that the Blue Shield of California plan being offered limits her choice of doctors and hospitals just to Marin County, where she lives, just north of San Francisco. But, she says, “All my doctors are in San Francisco. I live 20 minutes from San Francisco. In fact, it’s more convenient for me to go to San Francisco than to the hospital here in Marin County.” Continue reading

Why Narrow Networks May Not Be Such A Bad Idea

By Dan Diamond, California Healthline

Search Covered California’s website, and you’ll find a list of 33 “frequently asked questions.”

The 33rd and final question — below questions like “Why should I buy health insurance?” and “I’m pregnant and do not have insurance. What health coverage is available for me?” — is this one: “Will patients be able to keep their same doctor when they purchase health insurance through Covered California?”

The question may be last on Covered California’s list, but it’s top-of-mind for many consumers. About one million Californians, and millions of other Americans, are losing their health plans through the individual market and turning to Obamacare’s new insurance exchanges to shop for replacement coverage. And in many cases, it’s still unclear if the family doctor will be coming with them.

The Mechanics Behind Narrow Networks Continue reading