It is a reasonable expectation to assume that when a family enrolls in a health plan through Covered California that there will be local doctors to address their health care challenges. Unfortunately, some health plans have a virtual vacuum of providers in fairly large communities. This is the case for members of Anthem Blue Cross PPO individual and family plans in Livermore, California. For one family, the nearest in-network pediatrician is over 15 miles away from their Livermore home.
Anthem Blue Cross offers virtually no doctors to Livermore residents
While I’m not often surprised by how the health insurance companies dodge offering a decent network of providers to their members, the vacuum of providers in the Livermore area is something of a shock. Livermore is an East Bay community with an approximate population of 83,000 people. It is a middle-class enclave next to Pleasanton and Dublin. Livermore is not an isolated community. Many families choose to live in Livermore because of its proximity Bay Area employers.
Blue Cross in-network pediatrician is 15 miles away
All one Livermore family was trying to do was find an Anthem Blue Cross in-network pediatrician for their son who was born in July. The Blue Cross provider search tool indicated the nearest pediatrician was 15 miles away in Milpitas. I called Blue Cross and they confirmed that there were no pediatricians in the network within Livermore, California.
Are these Livermore doctors really in Livermore?
A search for just any doctor on the Anthem Blue Cross website indicated there were only 3 doctors in Livermore. However, even though the doctors had Livermore addresses, the search tool indicated they were over 14 miles away. It is unclear if the doctors are really in Livermore, or if the Blue Cross member wants to see them on an in-network basis, they have to travel to another location 14 miles away. (See Doctors use bait and switch tactics)
Medi-Cal has more doctors than Blue Cross
The Alameda Medi-Cal health plan, Alameda Alliance For Health, shows 5 pediatricians within 6 miles of the Livermore zip code of 94550. Why does a no cost Medi-Cal health plan have more and closer providers than a private health? Blue Shield PPO individual and family health plan indicated at least one pediatrician in Livermore with a couple more in Dublin.
For some people, traveling 15 miles to see a doctor is not an inconvenience. For a young family, juggling jobs, having to see a physician 15 miles from their home can be a significant burden. In this family, only one of the parents has a car and drives. This means the other parent must navigate public transportation to take the newborn for the numerous well-baby visits. A conservative time estimate is 8 hours to get ready, make bus connections, wait in the doctor’s office, and then travel by different bus connections back home.
Traveling to see a doctor costs money
Even if the well-baby visit is “no cost”, a whole day is lost just attempting to see an in-network pediatrician with Blue Cross if you live in Livermore. There are no guarantees of any easy doctor visit even with a car. Bay Area traffic can turn a 30 minute car trip into 2 hours at the wrong time of day. The lack of Blue Cross doctors and pediatricians in Livermore is shifting the costs onto the members. They are being forced to waste more time traveling to appointments and lost productivity at work.
Using out-of-network pediatricians is expensive
The alternative is to find a local doctor who is out-of-network. This would mean the family must shoulder an even larger portion of the health costs as there is essentially no coverage for routine out-of-network health care costs. Of course, that is what Anthem is banking on. Members will choose to go out-of-network, pay for the full cost of care, and Anthem Blue Cross doesn’t have to pay any claims.
The Department of Health Care Services (DMHC) is the regulating agency for Anthem Blue Cross individual and family plans. While DMHC verifies that the health plans have a certain number of doctors and hospitals to server its members, it doesn’t look like they check to see if certain portions of the region lack local in-network health care providers. But who really knows which providers are local when the Anthem Blue Cross search tool shows Livermore doctors 14 miles away from the city.
Covered California mandates PCPs
Covered California has said they will have a provider directory search tool for consumers in 2017. But if the weakest link is the information provided by the carriers, and Anthem can’t supply correct information on their own website, how can Covered California verify their information is correct? Pile on top of this that Covered California is mandating the health plans assign a Primary Care Physician (PCP) to all their members. What good is a PCP if the doctor is hours away from the family because Blue Cross only has three doctors in Livermore?
Blue Cross rates increasing for regions with no doctors
Oh, did I mention that the Anthem Blue Cross rates in Alameda County are increasing by 18% for 2017. In addition, Anthem Blue Cross is switching from a PPO to an EPO which means there will no out-of-network coverage at all in 2017. I know this family has been loyal to Blue Cross, but they are being forced to look at different carriers for 2017 because of the lack of any providers in the local Livermore area.