By the time I had all the fun in the urologist’s office, the prostate pain had virtually disappeared. My PCP and I had theorized before the PSA test that the new mountain bike I bought, with the knife-like seat, may have traumatized the pudendal nerve, a common problem among cyclists. I had stopped riding my new bike and the pain gradually subsided. The next PSA test result was a 4, confirming that I needed to buy a new bike seat.
Doctors Networks Coverage
Posts related to doctors and health insurance plans, in-network, and their support of health care reform.
Health Net is bringing primary, preventive and urgent care right to our members — literally. Starting May 1, 2018, your PPO clients — individuals and all group sizes — will have a new way to connect to care with a Heal doctor who can make house calls.
Because of all of the numerous ways a provide network search can give incorrect results, I am now recommending that people print out a list of providers in their area. Usually the list can be created in a PDF format that is searchable with Adobe Acrobat Reader. You can look through the list of doctor names alphabetically. You might see Dr. Balabat and realize that is your doctor when you thought the name was spelled Baladat.
Before I start gathering coverage information, I create a table with preferred or “must have” providers, hospitals, and drugs in rows, with the available health plans across the top columns. I then mark which health plan has the providers in-network and if the drugs are covered and at which Tier.
Forcing either the health plans or the providers to post a list of costs for routine services is a very low impact way of adding consumer information to the health care market. The government is not telling the providers what they should charge. The government is not telling the health insurance companies what they should pay the providers. A law mandating a simple fee schedule like Kaiser Permanente has published will create price transparency and allow consumers to compare valuable health care cost information across a variety of health plans and providers. This will ultimately slow down the rate increases as providers compete not only on patient satisfaction, but on price as well.
One of the first filters in selecting an EPO or PPO individual and family plan, either through Covered California or off-exchange, is determining if your current doctor is in-network. For all the enhancements to online doctor directory search tools, they still suck. They are not consumer friendly. Consumers are given either too many conditions to select or the provider search tool offers too little information.
Covered California has implemented several changes to health plans to increase the access of doctors for patients. All EPO and PPO members will be assigned a Primary Care Physician and they have lowered the office visit copay for most plans, in addition to the no cost office visits for preventive care. But the one accessibility challenge that has not been addressed is the office hours of most doctors. It would make far easier for health care consumers to get care if they could visit their doctor in the evening or on weekends.
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.
The narrow doctor networks of California’s individual and family health insurance plans are actually smaller than first thought as doctors use a bait and switch tactic to lure in patients and then bill for their services with “out-of-network” providers. The health insurance companies have little control over this practice that has a doctor listed as in-network for their health plan, but the services are actually billed by a facility that is out-of-network. This bait and switch tactic, aided and abetted by confusing online provider search tools and opaque billing statements and codes, leaves consumers paying more for health care services than they should.
With the announcement that Blue Shield of California may be dropping Sutter Health physicians and hospitals from their list of network providers in Northern California, Blue Shield members are wondering if their health plans are any good. For all the good of health care reform under the Affordable Care Act consumers are learning that doctors […]