"I now stand to lose either my coverage or my doctors when I have to renew this year," said Roberts, 61, editor of a trade publication. "Tough choice to make when you're held hostage by the insurance industry."
Blue Shield of California downplayed the new restrictions. The insurer still will cover out-of-state emergency care, urgent care and some limited primary care, company officials said. It also will work with patients already undergoing a course of treatment in another state, and offer members the opportunity for telephone consultations with out-of-state doctors, spokeswoman Amanda Wardell said.
"We have a large network of providers in California," Wardell said. "We're trying to focus on affordability and part of that is focusing on our provider network in California. We're able to manage our costs better."
Kevin Knauss, a Sacramento-area health insurance agent who writes the InsureMeKevin blog, said he's received calls from worried clients, including a man who divides his time between New York and California and a family that had hoped to seek highly specialized care outside California for their son's brain disease.
The move isn't particularly surprising to Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms.
In California's competitive insurance market, she said, insurers are narrowing their networks of doctors and hospitals to lower their costs.
"Consumers are price-sensitive to premiums," Corlette said. Under the ACA, "there is a more limited set of tools for insurers to lower premiums. They can't discriminate against people based on their health status."
Roberts, the Doyle resident, said that if she can't get care in Reno – a roughly 45-minute drive from her home – she'll have to travel through the Plumas Forest to Quincy, Calif., which takes nearly twice as long.
Roberts said she considered changing to Anthem Blue Cross, which still allows members access to out-of-state care through the Blue Card program. But she recalled having difficulties obtaining the care she needed when she was an Anthem client in the past.
"As a result, I've chosen to stay with Blue Shield and let the chips fall where they may," she said.
Roberts' health problems are significant: She nearly died from Valley Fever and had part of her left lung removed. She also suffers from heart disease, asthma, allergies and chronic obstructive pulmonary disease.
Dena Mendelsohn, a San Francisco-based senior attorney for Consumers Union, said all insurers need to ensure that their members – including rural residents – have timely access to both primary care and specialty doctors.
No law forces insurers to provide non-emergency care outside their regions, Mendelsohn said, but if Blue Shield is "lemon-dropping" – trying to get costlier members to drop their coverage – "it would be problematic."
"It's really important for consumers to really shop around and understand their options during open enrollment season," which ends in California on Jan. 15, Mendelsohn said.
"Blue Shield's trims to out-of-state coverage give some Californians the blues" originally appeared in California Healthline, a service of the California Health Care Foundation, which is produced by Kaiser Health News. Kaiser Health News, a not-for-profit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.
