Our own Roy is in today's Wall Street Journal talking about Errors in the Provider Lists. For the hard copy, see page six.
If you can't surf over (it may need a subscription), here is the article.
Roy would love it if you'd go over the the WSJ and write a comment!
Oct. 30, 2013 7:34 p.m. ET By Melinda Beck
Some plans listed him at an address that he had left three years ago. Others had the right address, but Dr. Daviss treats only hospital inpatients and isn't available for people looking for a therapist.
"Not one insurance company has contacted me to ask if I am accepting new patients," said Dr. Daviss, who complained to Maryland exchange officials.
Many new health exchanges don't yet let shoppers see which doctors accept which insurance plans. Where exchanges do post the so-called provider lists, they often contain inaccurate or misleading information, some doctors say, including wrong specialties, addresses and language skills, and no indication whether providers are accepting new patients.
Exchange officials blame the insurance industry, where inaccurate and out-of-date provider lists are nothing new. "I don't think we realized that the underlying data had quite this number of problems. Now, it's becoming more transparent," said Joshua Sharfstein, Maryland's secretary of health and the chairman of its exchange.
Robert Zirkelbach, spokesman for America's Health Insurance Plans, an industry trade association, said, "Health plans do everything they can to ensure their provider networks are up-to-date."
The new health exchanges are supposed to offer a transparent shopping experience, including clear information on participating doctors. But in addition to providing wrong information, the lists may give consumers a false impression of how big the networks are, some physicians say. Several exchanges warn shoppers to ask doctors directly if they accept the new plans.
Insurers say that in some cases, doctors may not be aware that they are in provider networks for the new insurance plans. Some contracts allow carriers to move physicians into new networks or lease their names to other insurance companies, even without keeping them informed.
"These networks are often in flux—it's part of the Rube Goldberg contraption that is the U.S. health-care system," said Peter Beilenson, chief executive of Evergreen Health Co-op, a new Maryland nonprofit that leased its network of doctors from PHCS, a large provider group that is part of an even larger group, MultiPlan Inc., which contracts with 900,000 health-care providers nationwide.
Evergreen plans to inform some 7,000 Maryland doctors in the PHCS network that they are in its new network in mid-December.
Some carriers are using their usual provider networks for their new exchange plans and haven't notified those doctors to expect more patients. Others are offering low-cost plans and have asked providers to take reimbursement cuts, though many haven't specified the new rates yet.
Some doctors are surprised to see their names listed in new insurance plans on the exchanges, though they haven't signed new contracts or aren't accepting new patients. Insurers offer a variety of explanations, reports Melinda Beck. Photo: Getty Images.
Blue Shield of California said not enough doctors signed up for its exchange plans, particularly in rural areas, to meet state standards, so it notified several hundred of its contracted physicians that they were being moved into the new network as well, at their usual rate, said spokesman Stephen Shivinsky.
He said that Blue Shield sent Dr. Thorp two such notices at a rural clinic where he treats patients, and that its contract with him covers any office he practices in. Steve Nord, the administrator for Dr. Thorp's private practice, said the contracts are very different. "There's obviously been a miscommunication," Mr. Nord said.
Unlike many states, California permits insurers to use "all-products" clauses in contracts with doctors, requiring them to participate in any plan the carrier offers, regardless of the rates. As a result, the California Medical Association said some doctors might be caught off guard.
"Come January, some practices could find they have a lot of new patients coming through their doors at less than break-even rates," said CMA associate director Brett Johnson.
David Aizuss, an ophthalmologist in Encino, Calif., said he won't sign all-products contracts and has declined requests to join the new plans. So he, too, was also surprised to find himself listed as accepting five new Blue Shield plans on the California exchange. Even if Blue Shield does pay his usual rates, Mr. Aizuss says, "I don't know if we have the capacity to handle many new patients."
Blue Sheild's Mr. Shivinsky said Dr. Aizuss is one of a handful of ophthalmologists listed erroneously on Blue Shield exchange plans. The list will be corrected by mid-November, he said.
The California exchange, called CoveredCalifornia, has been plagued with other provider-list problems, too. Officials took the doctor search tool off-line for more than a week because many doctors' specialties were listed erroneously.
The search tool was back up this week with no specialties given. But spokesman Roy Kennedy said it would soon add a hot line for doctors to call to report errors with their listings.
Write to Melinda Beck at HealthJournal@wsj.com