I posted the following on my personal FB page about an hour ago. Reposting for wider consumption:
I’ve found that here in CA – as well as in other states – Blue Shield is offering plans through the Affordable Care Act exchanges that have limited networks. For example, the PPO you buy on CoveredCalifornia is not the same as the PPO you buy directly from Blue Shield. This is not supposed to happen. The exchange is supposed to be simply a marketplace where you can comparison shop for plans. It’s not supposed to be a marketplace for substandard plans.
So I sent a note to Blue Shield, and the letter below is what I got back. They’re claiming the on- and off-exchange plans should be the same. Oh really? Then why are they picking and choosing which doctors they include in their on-exchange networks? Every doctor I’ve spoken with has said this is the case. The doctors also tell me that when they are invited to participate – IF they are invited to participate – the reimbursement rates for on-exchange plans are prohibitively low.
The letter also says to check the website for which providers are in or out of network. That’s comical because the website is inaccurate, and people are signing up for plans thinking their doctors are covered and finding out once they get to the office that they aren’t. (In many cases, patients will call and ask their doctors if they are in network, and the doctors themselves don’t even know because the insurance company has been totally unresponsive). My GP says he has contacted Blue Shield several times now asking they either include him in the network or take the information that he is in-network off the site, and they have yet to do anything about it.
See, it benefits Blue Shield to keep the errors because they can draw in more customers with that misinformation. This way the networks appear to be larger than they truly are.