A ruling in California that two major health insurers failed to give consumers accurate information about providers participating in their plan networks could force others in the industry to quickly improve their protocols.
The California Department of Managed Health Care released scathing reports Tuesday regarding plans sold by Anthem Blue Cross (a subsidiary of investor-owned WellPoint) and Blue Shield of California on Covered California, the state's Obamacare exchange.
The report on Anthem (PDF) found that 12.5% of the physicians listed in the insurer's provider directory for exchange plans had inaccurate locations. Further, the state called thousands of doctor offices and found almost 13% did not take patients who had Anthem's exchange plans even though they were listed as in-network.
The state's report on Blue Shield (PDF) said 18.2% of doctors in the plan directory were not located where the insurer said they were, and 9% of doctors were not willing to accept patients who had Blue Shield's Covered California plans.
“You can't have health reform that's based on insurance markets that are selling standard products and not have this information available to consumers and purchasers,” said Gerald Kominski, director of the UCLA Center for Health Policy Research in Los Angeles.
Anthem and Blue Shield, which together captured more than half the enrollees in the state's exchange plans this year, called the reports “inaccurate” and said the state's methodology was flawed because it relied on phone surveys.
There are no immediate repercussions from the state's analysis. Regulators said they referred the findings of the reports to the state Office of Enforcement, and a follow-up survey will be conducted in six months. No financial penalties were levied. But the state's scrutiny reflects growing concern about the adequacy of provider networks sold on the exchanges and the accuracy of information provided to consumers.