Politics & Government

Anthem, Blue Shield faulted for doctor lists

California regulators determined that Anthem Blue Cross and Blue Shield of California violated state law and significantly exaggerated the number of doctors available and accepting patients under Covered California, the state’s year-old health insurance exchange.

Representatives for the insurers questioned the methodology used in the probe and dismissed a pair of reports released Tuesday as flawed.

A five-month investigation by the Department of Managed Health Care found more than 18 percent of doctors listed in Blue Shield’s directory were not at the location listed and nearly 9 percent were unwilling to take patients enrolled in Covered California, “despite being listed on the website as doing so.” Some 12.5 percent of physicians in Anthem’s directory weren’t at their listed locations and nearly 13 percent were not accepting state exchange patients.

DMHC Director Shelley Rouillard said in a statement that inaccuracies in the insurers’ online provider directories limited enrollees’ access to care and “resulted in an unacceptable consumer experience.”

The deficiencies, three of which the report says remain uncorrected by the insurers, were referred to the agency’s enforcement office, and possible fines loom. Regulators will open a follow-up investigation in six months to ensure the deficiencies are corrected, Rouillard said.

Release of the investigation comes as the health insurance exchange opens for its second year of business with the goal of enrolling another 1.7 million people in insurance coverage in 2015. The reports are based on surveys of doctors listed in directories and were opened after thousands of customers complained about having trouble finding in-network physicians.

Anthony Wright, executive director of Health Access California, said the probe into the exchange’s two largest insurers revealed “deeply troubling” results.

“If significant numbers of doctors listed aren’t where the insurers say they are, that’s a big violation of trust to premium-paying patients,” he said. “The networks were narrower (than) advertised, and consumers made choices based on misleading information provided by the plans.”

Wright called on regulators to impose fines and corrective action plans on insurers that “can’t keep their most basic commitment to consumers to have accurate and adequate networks and access to care.” He also took aim at the plans for attacking the results of the investigation.

For months, the health insurers have said they were working to tackle the issues. Steve Shivinsky, a spokesman for Blue Shield of California, said officials acknowledge and share the state’s concerns identified during the first year of the Affordable Care Act, also known as Obamacare.

“We are committed to continuing to work with the department on our shared mission of serving consumers across the state,” he said. “At the same time, we believe that the department’s final report is misleading and has the potential to further confuse members by significantly overstating the severity of the issues.”

A spokesman for Anthem suggested it already made big improvements and said there may be a “disconnect” inside the doctors’ own offices. Darrel Ng said Anthem checked out the providers who told regulators they would not serve Covered California members, but 99 percent had signed contracts that said they would.

“Anthem Blue Cross has already acknowledged that while the vast majority of providers in our directory were correct; however, some providers were inadvertently listed in error,” said Ng, adding that the plan continues to take steps to improve the accuracy of its provider finder.

“In addition, Anthem created a special hotline for members who needed assistance finding providers and contacted hundreds of thousands of our members via email and postal mail about the availability of the service. In the six weeks since the mailing, the hotline has received only 17 calls.”

While the reports recognize plans have taken steps to address the issues, Covered California Executive Director Peter V. Lee said ultimately providing accurate information to consumers will depend on a partnership between insurance plans, physicians and their front office staff, with the support of Covered California.

Said Lee: “We are confident that directories are much improved from what they were when this audit was conducted, and we encourage anyone who is uninsured to get covered by Feb. 15 knowing it will give them access to the care they need.”

Call Christopher Cadelago, Bee Capitol Bureau, (916) 326-5538. Follow him on Twitter @ccadelago.