SAN FRANCISCO (KPIX 5) – Some frustrated enrollees of Covered California are accusing the insurance exchange of false advertising, after they said doctors listed on their website aren't actually accepting Covered California plans.
After signing up, Guda Venkatesh couldn't wait to pick his new doctors. "The first thing I wanted to do was to get a primary care doctor," he told KPIX 5 ConsumerWatch.
Venkatesh chose an Anthem plan specifically because the Covered California website said the plan had a variety of Stanford doctors near him.
"Except when I started going through the doctors, each one and calling them up, none of them actually accepted the Covered California plan," Venkatesh recalled. He then showed a three-page list of supposedly in-network doctors, but none accepted his insurance.
Is it a case of false advertising? Anthem said it was a mistake and told KPIX 5, "Like other insurers, (Anthem) will continue to double check its provider lists to improve accuracy."
KPIX 5 went to Covered California to ask if the list is their responsibility. Dana Howard with the exchange said, "Yes, it is our responsibility. However, we do not have an audit that goes on 24/7 to make sure that every bit of information is indeed accurate."
Howard said if you signed up for a plan and it's not what was advertised, there is still time to switch. Open enrollment continues until March 31st.
He said switching insurers is a lengthy and complicated process that should not be attempted online. Enrollees must work with a customer service representative to avoid gaps in coverage.
KPIX 5 asked Howard if there are inaccuracies on the website. "Well, there may be," he said. Before signing up, Howard said it is crucial for enrollees to contact doctors to ensure they will be actually covered.
It was something Venkatesh assumed Covered California had done for him.
"The premise of Covered California is that you're able to compare plans and see which one is best for you. But if they are presenting that they have all these doctors in network but they don't, then it doesn't work," he said.
Anthem said it is constantly updating their list of doctors to ensure accuracy. The insurer said in some cases, doctors may not realize they have an agreement to accept patients on some of these new policies.
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