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Who’s Your Doctor?

As of last week more than 3.3 million Americans have signed up for private health insurance through online marketplaces under the auspices of the Affordable Care Act (Obamacare). California leads the nation with nearly 730,000 enrollees under its Covered California program. At the end of January Anthem Blue Cross led all other health insurers in the number of new Covered California enrollees, with Blue Shield of California only a percentage point behind.

In November I reported on the relatively prompt service a local health care customer received when using the Covered California system. With telephone assistance from a Covered California representative, the consumer navigated the online application process with relative ease (in half the time that the site warned about). The Covered California system proved even more of a positive in the matter of cost. Through subsidies, based on income (not possessions or property owned), the consumer's monthly health insurance premiums were cut more than in half. With the same company and a slightly better plan, the consumer's premiums for the first three months of 2014 were $115 less than the premiums for the last two months of 2013 under the old non-ACA, non-Covered California health insurance.

Now let's take a similar consumer from Mendocino County, whom we will call The Patient. The Patient has also had a reduction in rates under Covered California and the Affordable Care Act. A month or so before signing up for the new insurance, The Patient went in to a local doctor's office for an annual physical. A trace amount of blood came back in a urine test. A follow up PSA test, however, showed no prostate problems. An ultrasound more than a decade ago had disclosed a small to medium kidney stone, but The Patient had experienced no symptoms of passing a stone. (Anyone who has had one or viewed Tom Hanks' character's excruciation in the opening minutes of The Green Mile can attest to the obvious nature of a kidney stone passing).

The Patient's doctor recommended a visit to a Santa Rosa urologist. The Patient, feeling no obvious discomfort or pain, procrastinated through the holiday season and on into the new year of 2014. Finally, The Patient caved and called the urologist's office. The urologist's receptionist asked for The Patient's insurance info. The Patient responded with an ID number for his brand spankin' new Anthem Blue Cross plan. The receptionist added another question, “Is this a Covered California plan?”

“Yes, part of it is subsidized through Covered California.”

“We're not accepting Covered California plans.”

Stunned silence, according to The Patient. The receptionist must have picked up on this, for she told The Patient that she would double check and get back to him. As of this writing, The Patient reports no “getting back.”

Next, The Patient called his local doctor's office to report the problem with the urologist's office. Guess who else isn't continuing to see Anthem Blue Cross insurees who have used Covered California? That's right, our Patient's local doctor. The same office that willingly saw The Patient last autumn, billed through Anthem Blue Cross, and received payment through the same company. The Patient asked the local doctor's receptionist what he should do? Where could he go under his Anthem, Covered California plan? The receptionist reportedly hesitated for several moments before reciting the name of a nearby clinic.

On behalf of The Patient your intrepid writer checked with a Covered California agent, who stated that so many doctors are switching contracts with Anthem, Blue Shield, Health Net, and whatnot that Covered California has had to take down an internet page that identified which doctors (providers) were in which networks.

Confusing? Imagine a truly incapacitated patient having to deal with all these switches. Eventually, The Patient decided it would be easier for him to switch to a Blue Shield health plan in order to stay with his local doctor. That plan, identical in detail to an Anthem Blue Cross plan costs roughly 15% more per month. This writer asked two different Covered California representatives why identical plans would differ in price. One could almost see them shaking their heads on the other end of the phone line. The first rep said that the price could vary geographically. Another said, “Let's hope this is all sorted out by next year.”

Mendocino County residents who have used the Covered California system would be well advised to double check on whether or not their local provider (doctor/nurse practioner/physician's assistant) is still affiliated with the same insurance plan.

And let's hope that 15% increase isn't a “kickback” incentive to physicians for contracting with Blue Shield over Anthem Blue Cross. Worse yet, let's hope it's not just another case of a big corporation skimming 15% of the profits right off the top of every health care bill.

One Comment

  1. Mom N Pop February 24, 2014

    My neighbors who are a couple in their 50’s with limited income applied through covered CA last November. They were only offered Medical and their cards came right away. However, they were apparently “just temporary” and to date the male part of the couple has shown up at our local clinic for his appointment twice only to be told he is “not in the computer” and cannot get any help with his health problem. He is still trying to untangle it. Someone should talk to the PR people who are touting ACA and CoveredCA and tell them it doesn’t work. SAD!

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