Two Covered California health insurance plans misled consumers, regulators say

[Omaha Steve]

http://www.mercurynews.com/health/ci_26965329/two-covered-california-health-insurance-plans-misled-consumers?source=JBarTicker

By Tracy [e-mail]
POSTED: 11/18/2014 07:07:50 PM PST

Two major health insurers selling policies on the Covered California insurance exchange violated state law over the last year when they listed names of doctors in online directories who were not part of their networks.

Results of a five-month-long investigation into the practices of Blue Shield of California and Anthem Blue Cross of California by the Department of Managed Health Care released Tuesday revealed that:

Eighteen percent of the physicians listed by Blue Shield were not at the location listed in the provider directory. Of those who were listed, 8.8 percent were not willing to accept members enrolled in Blue Shield's exchange products.

Twelve and a half percent of the physicians listed by Anthem were not at the location listed in the provider directory. Of those who were listed, 12.8 percent were not willing to accept patients enrolled in Anthem's Covered California products.

FULL story at link.

[Tommy2Tone]

1. Are you trying to be the next Jonathon Gruber? n/t

[LeftyMom]

3. The OP or the Merc?

The merc is a well-regarded paper and this is a legitimate issue. I was offered an entire *plan* only to find out it wasn't taking new patients! And it was the one I selected because they had nearby doctors, the other plans available to me all had doctors in clinics whose reviews on Yelp featured words like "third world" "incompetent" "rude staff" and "four hour wait".

[NYC_SKP]

2. Mine did. Anthem. And I fought them and I won. About $500,000 in claims were covered.

They screwed up my DOB and nobody recognized any insurance but I got my brain surgery and follow up surgery and third surgery this month covered.

I'm still fighting them over a helicopter flight from one hospital to another, but feel confident that I won't have to pay for that.

They suck, and I need to try a different provider.

If I hadn't fought I'd be facing medical bankruptcy, for sure.

[Nye Bevan]

4. Good for you. You have to fight these companies.

I've concluded that their business plan is more or less to screw people over and hope that they don't fight back. While they do seem to give in a lot of the time when people do fight them, there are plenty of people who just give up and don't fight, and these people are where the profits come from. It's a rotten system, but that's what we're stuck with for now.

[NYC_SKP]

5. A surgeon told me that they use algorithms and know that x number of folks won't complain

If I was older, or dumber, I'd have gone crazy or given up.

I've got stacks of paperwork and have spent days on the phone.

Thankfully, Stanford Hospital and other providers have really taken my side on all these claims.

We shouldn't have to fight so hard.

[merrily]

6. You have been through a lot! I'm so sorry.

Glad for your victory, though.

[merrily]

7. ....

[kelliekat44]

8. Wow, wait until FOX blames this deceit on Obama. 24/7 coverage to the mindless. nt

[truedelphi]

9. Finally!! Some Justice that is not just "Just Us!" n/t