Exchange plans worry California docs

Dr. Mark Dressner says California’s public exchange need to act now to keep physicians in the networks. Dressner, president of the California Academy of Family Physicians, said doctors who treat Covered California exchange plan patients feel confused, frustrated and poorly paid.

  • Doctors say plan reimbursement rates are 20 percent to 40 percent lower than traditional plan rates. “Our physicians describe these payment reductions as unaffordable to their practices,” Dressner says.

“Carriers seem to think they can change contract terms by simply sending letters to the physicians. Physicians have trouble finding out what the plan contract terms are, or even finding out whether they’re really in a plan provider network”.

  • “In parts of California, for example, low reimbursement rates have resulted in a doctor rebellion, as nearly seven out of 10 doctors refuse to participate in the exchanges.”

Meanwhile, nationally known health insurance providers like United Healthcare, Aetna, Cigna are staying out of the Obamacare exchange marketplaces. Anthem Blue Cross and Blue Shield are in, but are sharply narrowing their networks to exclude many doctors, as well as elite hospitals.

As a result, well-known hospitals like Los Angeles’ Cedars-Sinai, New York’s Memorial Sloan-Kettering and the NewYork-Presbyterian Hospital will be out of reach for many exchange patients.

*Modified from a and article

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