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Frustrations Within California’s Health Insurance Companies

Many Covered California members, doctors and even agents are frustrated with the treatment of Health Insurance Companies in California.

Doctors who were originally enrolled in Covered California’s health insurance networks are deciding to drop out. For them, the billing processing is too difficult and time consuming, and the fee-structures are too low. Furthermore, Anthem listed nearly 1000 doctors incorrectly in their network, naming doctors who had never been enlisted.

Covered California members and even members outside the exchange are realizing that their original in-network doctor is no longer inside the network. This hit Anthem members especially hard, as using out-of-network providers is not covered under the EPO health plans (unless in true emergencies). Each time, a health insurance policyholder in need of medical services has to verify that the doctor is still in the network of the health plan. Even in addition to this, the patient has to verify that the  doctor sent the lab work through a contracted laboratory. If the doctor’s office does not use the contracted laboratory, the patient will be charged with  high out-of-network services fees. So Californians, make sure to verify that the doctor, hospital, laboratory, and any other medical service provider is in network, as otherwise you might be hit with high charges. The Open enrollment period ended, so you are stuck with your health plan until the end of the year. Only if you experience a special qualifying life event, such a birth of a child, marriage, a move from your county, a loss of insurance through your work, etc., will you be able to reapply for a new health plan before November 15th 2014.

Agents are stuck in the middle. They are trying to help consumers with payment and claims processing, trying to explain the importance of  familiarizing yourself with the insurance company websites, and are themselves experiencing huge commission cuts and wrongful commission payments. The last cut from Health Net has broken every agent’s back.

Frustration from members, doctors and agents against the insurance companies, the Affordable Care Act, and the feeling of being completely helpless against the insurance industry power is reality in California.

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