Central Coast

Dear Jon: Blue Cross customer upset doctor won't accept health insurance

Many doctors on the Central Coast opted out of the ACA compliant plan

You would think that if you sign up for insurance through the health exchange known as Covered California that your doctor would take your insurance. That's turning out not to be the case with Blue Cross coverage in Monterey and other counties in the state. Mike in Carmel Valley asked, "Dear Jon, why doesn't my doctor take my Blue Cross insurance? He did last year." What I found out is disturbing for many patients.

I called Blue Cross and spoke to company representative Darrel Ng, and what I'm told is that many with Blue Cross before the Affordable Care Act had a different network of doctors. The reimbursements for doctors were higher last year as well. When the ACA went into force this year, those Blue Cross customers who signed up through Covered California were transferred to ACA-compliant plans. Ng says these customers received a letter in the mail that this would be happening.

What occurred with the transfer was essentially moving patients to a new and smaller network of doctors. These doctors have signed a contract saying they'll accept the new rate structure from Blue Cross, which is a lower reimbursement than other plans Blue Cross offers. Some of these doctors refused to sign the deal and were left off the Covered California Blue Cross plan. That means patients were left holding the bag.

Ng also said that Blue Cross did a survey of customers and the No. 1 factor with these customers was lower-price health insurance. So to achieve this, Blue Cross lowered it's pricing for Covered California and also lowered it's coverage, which forced the lower reimbursements for doctors. This turn of events forced many doctors on the Central Coast to opt out of signing on with Anthem Blue Cross' ACA complaint plan.

Blue Cross spokesperson Darrel Ng was quick to point out that the State Insurance Commissioner has approved the rate structure for the ACA-compliant Blue Cross plans. Even so, one of my sources in the health care field told me that 46 doctors in Monterey opted out of taking the Covered California-offered Anthem Blue Cross plan.

So if you want to find a doctor that takes your Blue Cross plan, call the number on your health insurance card or go online with the Blue Cross web tool.

If you still want to see your same doctor and he/she doesn't take your Anthem Blue Cross plan, the doctor may see you as an "out of network" patient at a higher cost to you. Or you could pay cash at a negotiated rate with your doctor.

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