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Insurer Admits Nearly 1,000 Doctors Wrongly Placed On Covered California Provider List

SAN FRANCISCO (KPIX 5) -- Two months after KPIX 5 ConsumerWatch first reported about some doctors listed on the Covered California exchange were actually not accepting the plans, insurer Anthem Blue Cross admitted that nearly 1,000 doctors were erroneously listed.

According to a statement by the California Medical Association, the insurer recently notified 965 physicians that they were wrongly placed on the exchange's list. The notice, which was posted on April 9th, stated that the doctors were "inadvertently" listed for "a certain period of time" during the open enrollment period.

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The CMA said Anthem Blue Cross acknowledged the error after receiving a number of complaints from physicians who believed they were listed inaccurately as participating.

Guda Venkatesh, a Covered California enrollee, was one of those affected. He told KPIX 5 in February that he chose an Anthem plan because the 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 said.

"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 in February.

State regulations allow insurers to change their provider lists without notice. Lists must be updated quarterly, but regulators admitted to KPIX 5 that there is no system in place to check.

Anthem said the affected physicians were paid at 100 percent of Prudent Buyer PPO rates for services between January 1st and March 31st. Claims for dates of service on or after April 1st will be reimbursed as out-of-network, according to the insurer.

Regarding patients, Anthem said they notified those who saw an out-of-network that they would need to either select a new in-network physician or change to a different plan by March 31st, or face higher out-of-pocket costs. Patients were also advised of their right to request continuity of care with the out-of-network physician.

Anthem sent this statement in response Monday evening:

As we have said in the past, Anthem Blue Cross continually works to improve the accuracy of our provider directory. In the process of updating our provider database, we found that while the vast majority of the listings were correct, there were some providers inadvertently listed. Many of the doctors inadvertently listed decided to join Anthem's network during open enrollment period anyway and overall, Anthem has added nearly 2,000 doctors to our exchange network this year statewide.


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