The relief of finally getting a health insurance policy is being replaced with an empty feeling as people look for a doctor who will accept their new insurance. Many of our clients are discovering their existing doctors are not taking the new insurance, and the list of participating doctors is limited. Even when new participating doctors can be found, many are not accepting new patients.
Clients are learning this applies especially to pediatricians. As of this writing in January 2014, most pediatricians in the San Luis Obispo area are not accepting any more Medi-Cal / CenCal patients, even from among their current patient list.
Pediatricians
Most pediatricians limit the amount of Medi-Cal patients they see. This is done because the reimbursement rate for patients on Medi-Cal is lower than that of private insurance. And with so many children now qualifying for Medi-Cal (because of the Affordable Care Act) pediatricians are being flooded with Medi-Cal requests from new and existing clients.
This results in a difficult situation for parents. Their children’s pediatrician with whom they have built a multi-year trusting relationship is no long able to see their children. This begins the very difficult task of searching for a pediatrician who will accept their Medi-Cal insurance … a next to impossible task in this new insurance climate.
There is an option that can help alleviate this situation, and that is the purchase of a private insurance plan for the child. The plans run around $160 / month per child and can be in place alongside Medi-Cal.
Adults
The Affordable Care Act made significant changes to the nature of insurance and policies. These changes include:
- charging everyone the same premium amount, regardless of health condition
- accepting all applicants, even those with expensive medical treatments
- adding comprehensive benefits to every plan.
These three items have a significant impact on the costs to the insurers, causing the need for two key cost-savings measures: premium increases and “cost effective networks.”
We are seeing premium increases between 30-100% of past premium amounts. But even more shocking have been the changes to the network of physicians / hospitals. To contain costs, insurers have created a second tier network that runs alongside their traditional network. Physicians were offered a chance to be in this new network in addition to the traditional one; however this new network would reimburse them at lower rates. As you can imagine, many physicians have not opted to join the new network and have decided to only take plans that use the traditional network (grandfathered and group plans).
This new network is for ALL plans that conform to the Affordable Care Act (new individual and family policies as of 1/1/14). This includes plans purchased from Covered California, direct from the insurance company and plans that replaced old plans as of 1/1/14.
What Now?
Finding a doctor is becoming increasingly difficult, both for adults and children. The best advice is to go to your insurer’s website and search for doctors in the new network (although we are finding the information is only about 70% accurate).
To perform a search with Anthem Blue Cross:
- Visit the Anthem Blue Cross website
- Locate the “Find A Doctor” tool on the right side of the page
- When prompted, choose “Pathway X PPO” for the network and anything for the plan.
To perform a search with Blue Shield:
- Visit the Blue Shield website
- Use the “Find a Provider” tab on the top of the page
- Find the choose the section titled “Select a Plan”
- Choose “2014 Individual and Family PPO (Including Covered California)” as the type of plan
- Select your type of plan under “Select Sub Plan”
Don’t take it for granted that the information regarding whether the physician is taking new patients is correct. Call the physician’s office to verify whether they are accepting new patients and your insurance—and do this sooner rather than later. Many people are in your boat. We also recommend checking the doctor’s reviews on Yelp.com.
