State regulators say Anthem Blue Cross and Blue Shield of California provided “untrue” or “misleading” information about physicians connected with their health care policies sold via Covered California.
Anthem Blue Cross and Blue Shield account for more than half of the business done on the state Obamacare health-care exchange. Both of the insurance giants responded that there were problems with the state’s methodology, but admitted some errors and have updated their physicians directories for Covered California consumers.
The error-riddled physician directories initially provided by Covered California’s web site were an early source of embarrassment as the marketplace got under way last fall. The lists were removed from the state’s web site due to many reported problems, with consumers instead directed to health insurance providers’ own lists.
The California Department of Managed Health Care fielded dozens of complaints about inaccurate listings and launched an investigation.
DMHC investigators concluded that Anthem Blue Cross and Blue Shield made representations “that were either untrue or misleading and which were disseminated, at least in part, for the purpose of inducting persons to enroll in the plan.”
Roughly 13 percent of the Anthem doctors listed as participating in the insurers’ networks for Covered California were not, state investigators found. For Blue Shied, the percentage was almost 9 percent. The survey found many physicians were not in the locations cited by the insurers’ directories.
Insurers said some of the blame should fall on physicians’ offices, which gave some consumers wrong information about participation in networks.
Anthem said the state used “unsound methodology to obtain its raw data, and then made misleading and inappropriate conclusions based on inaccurate data.”
The state intends to revisit the issue in about six months.
Results of the probe were released just as enrollment began for the second year under the Affordable Care Act.
U.S. Rep. Jared Huffman said his constituents in the North Coast area were affected by “chaos and confusion created by inaccurate and misleading information on the physician networks for Anthem.”
“This action by DMHC brings much-needed accountability and ensures consumers that regulators are working to protect their interests,” said Huffman, a Democrat from San Rafael.
In June, Huffman wrote the president of Anthem Blue Cross complaining about the issue: “Over 90 percent of Northern California enrollees have plans from Anthem Blue Cross; failures in your network mean that an entire region of our state may be left behind in the promise of affordable, adequate health care,” the congressman wrote, seeking assurances the problem would be fixed for the next open enrollment.
Covered California sells private health insurance, typically to consumers who are eligible for government subsidies. The uninsured are required as of this year to buy coverage, or to pay penalties.
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