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A month into the most sweeping changes to healthcare in half a century, people are having trouble finding doctors at all, getting faulty information on which ones are covered and receiving little help from insurers swamped by new business.
Experts have warned for months that the logjam was inevitable. But the extent of the problems is taking by surprise many patients — and even doctors — as frustrations mount.
But when she went to her oncologist's office, she promptly encountered a bright orange sign saying that Covered California plans are not accepted. www.latimes.com...
The issue hit home for the Nelsons several weeks ago when their current health insurer, Aetna Inc., said they were among thousands of customers in California whose coverage will be canceled at year end. As a result, they will need to buy a new policy just as the federal law reshapes the market.
How would the "Oncologists office" know where she bought her Insurance from? They would just know the Insurance company and NOT whether it was purchased on an exchange or direct from them over the phone.
You are not denying that the signs have been put up in the offices, are you?
You are just asking a question that isn't relevant, right?
Danielle Nelson said Anthem Blue Cross promised half a dozen times that her oncologists would be covered under her new policy. www.latimes.com...
Question: There has been much talk about restricted provider networks in the Covered California plans. If the plans have to be the same as those offered outside the marketplace, how are they restricted? Or all all individual plans restricted in comparison to group plans? Can you shed some light on this subject?
Answer: Individual plan provider networks have been "narrowed" for 2014 as a way of controlling costs. That's because a smaller number of medical providers are willing to agree to lower contract rates. Carriers who offer qualified health plans in the exchange must "mirror" those plans (including networks) outside of the exchange, so the individual plan networks are identical in the exchange and off the exchange. Group plans will generally have broader networks than individual plans, if not the same as pre-2014.
Why are Networks Restricted?
Just signed up for Blue Shield on Covered California because they said on-line that my current doctors were preferred providers in their network, but when I called the doctor’s offices to verify this, one office told me that Blue Shield does not remove the doctor’s names from their list even if they are no longer preferred providers (which, in this case they are not anymore.) They told me to be wary of the Blue Shield list, as they have tried unsuccessfully for several years to get their name removed.