There was tremendous confusion over which doctors were in-network for the new individual and family plans offered through Covered California in early 2014. While the major health insurance plans offering PPO and EPO plans maintained the provider networks were the same regardless of whether they were purchased on or off the exchange, doubts persisted fueled by out-of-date online provider directories and the doctors themselves. A recent search of the online based provider directories shows that Health Net’s PPO plans have fewer doctors and hospitals than equivalent plans purchased directly from the carrier.
Health Net offers fewer providers to Covered California plan members
It was no secret that the provider networks were smaller under the new ACA individual and family plans than prior year offerings. If the Health Net online search tool is accurate, consumers purchasing a health plan through Covered California will have fewer providers to choose from than if they bought a Health Net IFP off-exchange. Health Net wouldn’t tell me why there were fewer providers. Regardless of whether Health Net doesn’t want the physician or hospital in the Covered California network or if the providers themselves opted out, having two separate individual and family networks will continue to breed confusion for consumers and providers alike.
Searching online provider tools
I performed online searches for providers of Anthem Blue Cross, Blue Shield of California and Health Net on October 6th. The searches were targeted on zip codes in Los Angeles, Marin, San Diego and San Francisco. The range for the physician search was set at a 10 mile radius and a 30 mile radius for hospitals. I used the same zip code for all searches I conducted. I filtered the results based on either the PPO or EPO plan offered in the area for off-exchange plans and plans sold through Covered California. I performed a final search for physicians and hospitals for small group PPO health plan in the region.
Is this a subtle form of discrimination?
Both Anthem Blue Cross and Blue Shield consistently had the same number of physicians and hospitals in the areas regardless of whether the plan was on or off the exchange. Health Net had 8% to 29% fewer physicians and 2% to 27% fewer hospitals for Covered California plans. The greatest disparity between on and off exchange plans was in Northern California. The plans off the exchange from Health Net are essentially the same price as those sold through Covered California to individuals and families. Did Health Net purposely short change Covered California members in terms of providers? Is the small provider network a subtle form of discrimination against Covered California consumers? Perhaps Health Net is just paying more money to providers in the off-exchange plans than those sold through Covered California.
|County – Zip Code||Off-Exchange||Covered California||% Difference|
|Los Angeles – 90023|
|Marin – 94901|
|San Diego – 92111|
|San Francisco – 94103|
Blue Shield search feature was simplest
The Blue Cross provider search filter doesn’t differentiate between on or off exchange. The selection is either PPO or EPO plans (including Covered California). There was no difference between the number of doctors and hospitals between Bronze and Platinum plans either. Blue Shield had the easiest provider finder tool to navigate. However, it can still be confusing with the variety of plans, from large group to Medicare eligible, being listed.
Anthem Blue has confusing plan names
Anthem Blue Cross has one of the most confusing provider search features. They have over 100 different plans listed under the heading Medical (Individual and Families) to select from. Some of the choices are clearly not for individual and family plans as there are some group and Medicare plans mixed in. The plan names are long and confusing.
Anthem Blue Cross Silver DirectAccess, a Multi-Sta (Pathway X – Tiered (EPO) / Individual via Exchange)
No search perfect or accurate
The searches I performed yielded the same number of doctors and hospitals for both Anthem Blue Cross or Blue Shield when I selected plans either on or off the exchange. This was not a scientific study and your results may vary. But it looks like the Blues do actually have one individual and family network in California for both their PPO and EPO plans. This is not to say that some of the physicians or hospitals may still be incorrectly listed as being in-network.
Group plans have more providers
I also did a quick comparison to small group plans offered by the three health insurance carriers. The numbers for Health Net seem to show that the off-exchange individual and family plans have nearly the same number of physicians and hospitals as their small group plans. That’s good news for consumers who purchased Health Net IFP PPOs off the exchange. As was expected, the small group networks for Blue Cross and Blue Shield were larger by anywhere from 10% to 30%.
|San Francisco – 94103|
|Blue Shield||Small Group||Covered California||% Difference|
New plans, new networks?
The wild card in all this comparison is that in 2015 Health Net will ditch their Covered California PPO plans and switch to EPOs. It remains to be seen if Health Net will further reduce its provider network or just rely on the fact that EPO plans have no out-of-network coverage to save money. Covered California promised to have a provider directory in 2014 but it became dysfunctional and was removed from the enrollment website. They promised to resurrect it in 2015, but they have since abandoned that notion until sometime in the future.
Look before you leap
Consequently, consumers are left with baffling online provider search tools to compare plans for one of the most critical elements of choosing a health plan – Does it support the family’s physician? For individuals and families who like the freedom of a PPO or even the more restrictive EPO, California has only inched forward in bringing some clarity to the numerous provider networks offered by the carriers.