Insurers limit doctors, hospitals in state-run exchange plans

California’s health insurance rates for a new state-run marketplace came in lower than expected this week, but one downside for many consumers will be far fewer doctors and hospitals to choose from.

  • People who want UCLA Medical Center and its doctors in their health plan network next year, for instance, may have only one choice in California’s exchange: Anthem Blue Cross.
  • Another major insurer in the state-run market, Blue Shield of California, said its exchange customers will be restricted to 36% of its regular physician network statewide.
  • Blue Shield’s exchange network in the Los Angeles area doesn’t include UCLA or Cedars-Sinai. Blue Shield said its statewide network for exchange policies will include about 24,000 physicians, compared with 66,000 doctors in its full preferred provider organization roster.
  • Cedars-Sinai Medical Center, one of Southern California’s most prestigious and expensive hospitals, said it’s not included in any exchange plans at the moment.
  • Health Net Inc., another exchange option in Southern California, said it expects to seek state approval to use its existing network, which includes both UCLA and Cedars-Sinai, for one of its exchange plans.
  • State officials sought to blunt that criticism this week, pointing out that the 13 health insurers selected will offer access to about 80% of California’s practicing physicians and hospitals. Covered California, the state agency implementing the federal healthcare law, said these trade-offs are necessary in many cases to keep premiums reasonable for California’s families.
  • Meanwhile, some insurance agents said it’s hard to judge these proposed prices in the state exchange without knowing what’s on the menu in terms of available providers. “Trying to determine whether these rates are low or high without knowing the provider networks is like trying to tell the value of a car when you can only see the tires — you don’t know if you are looking at a Ferrari or a Yugo.”

*Modified from a Los Angeles Times article

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