New Health Net EPO and HSP plans can half as many doctors in-network as the PPO plans.
While Covered California was preparing a large press announcement with the California Medical Association (CMA) about extolling the number of physicians that are participating in Covered California individual and family health plans, Health Net was releasing their list of providers in their new narrow network Exclusive Provider Organizations (EPO) and Health Service Plans (HSP). A search of doctors for both the Covered California Health Net EPO and off-exchange Preferred Provider Organization (PPO) plan shows that the EPOs can have half the number of physicians in the same county as the PPOs and virtually no medical groups are included in the EPO offerings.
Skinny EPO and HSP provider networks
The Health Net PPO plans were offered both on and off the exchange in 2014. Health Net admitted that there were more physicians in-network for the off-exchange PPO plan as opposed to the PPO plans purchased through Covered California. In 2015, all Health Net PPO Covered California plans have been replaced with either EPOs in Northern California or the new HSPs in Southern California. The PPO with the wider network of providers can only be purchased off the exchange for 2015.
Health Net doctors by county and plan type
The following number of in-network doctors, urgent care centers, hospitals and medical groups were retrieved by the Health Net provider search tool on December 1, 2014. These numbers may increase or decrease over time as providers opt in or out of the various Health Net plan types. PPO numbers are from the Individual and Family off-exchange plan selection. The EPO and HSP numbers are for the new Health Net 2015 PureCare One EPO or PureCare HSP plan type offered through Covered California. Also included, for comparison purposes, are the providers for Health Net Medi-Cal plans when offered in select counties.
| County | Doctors | Urgent Care | Hospitals | Medical Groups |
| Contra Costa | ||||
| PPO | 1483 | 10 | 6 | 10 |
| EPO | 770 | 4 | 4 | 0 |
| Kern | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 932 | 22 | 14 | 9 |
| EPO | 707 | 4 | 11 | 0 |
| Marin | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 487 | 1 | 2 | 3 |
| EPO | 214 | 0 | 1 | 0 |
| Merced | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 252 | 3 | 3 | 9 |
| EPO | 194 | 2 | 1 | 0 |
| Napa | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 271 | 2 | 2 | 5 |
| EPO | 154 | 2 | 2 | 0 |
| San Francisco | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 3447 | 5 | 10 | 12 |
| EPO | 291 | 3 | 6 | 0 |
| San Joaquin | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 784 | 5 | 6 | 16 |
| EPO | 476 | 5 | 5 | 0 |
| San Mateo | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 1167 | 1 | 6 | 6 |
| EPO | 436 | 1 | 3 | 0 |
| Santa Clara | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 5370 | 30 | 9 | 11 |
| EPO | 1476 | 7 | 9 | 0 |
| Santa Cruz | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 679 | 3 | 3 | 7 |
| EPO | 239 | 0 | 2 | 0 |
| Solano | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 382 | 1 | 4 | 6 |
| EPO | 124 | 0 | 2 | 0 |
| Sonoma | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 802 | 2 | 6 | 2 |
| EPO | 290 | 2 | 4 | 0 |
| Stanislaus | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 809 | 4 | 5 | 20 |
| EPO | 405 | 4 | 4 | 0 |
| Medi-Cal | 334 | 0 | 3 | 78 |
| Tulare | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 517 | 4 | 2 | 20 |
| EPO | 374 | 2 | 2 | 0 |
| Medi-Cal | 322 | 0 | 4 | 101 |
| Los Angeles* | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 15505 | 327 | 68 | 216 |
| HSP | 10301 | 0 | 0 | 3 |
| Medi-Cal | 5991 | 38 | 171 | 836 |
| Orange | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 7173 | 250 | 27 | 55 |
| HSP | 4347 | 0 | 0 | 0 |
| Medi-Cal | 595 | 3 | 20 | 166 |
| San Diego | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 4487 | 81 | 24 | 52 |
| HSP | 1973 | 0 | 0 | 0 |
| Medi-Cal | 998 | 20 | 9 | 96 |
| Riverside | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 2512 | 52 | 14 | 10 |
| HSP | 1792 | 0 | 0 | 0 |
| Medi-Cal | 707 | 0 | 8 | 101 |
| San Bernardino | Doctors | Urgent Care | Hospitals | Medical Groups |
| PPO | 2483 | 67 | 14 | 20 |
| HSP | 1879 | 0 | 0 | 0 |
| Medi-Cal | 738 | 0 | 8 | 84 |
- *Los Angels county actually includes the two rating regions of 15 and 16.
- Riverside and San Bernardino counties are only offered partial coverage by Health Net.
Noticeably absent from the HSPs and EPOs offered by Health Net are any medical groups. Medical groups are a collection of physicians, sometimes independent and other times associated with a hospital, that the health plan contracts with. If the Health Net provider search is accurate, medical groups have been cut out of being offered as in-network for many EPO and HSP plans within different counties. There is no out-of-network coverage with EPO and HSP plans. See: What’s best- EPO, HMO, HSP, or PPO plans?
Are networks the same on and off network?
So far the provider networks for both Anthem Blue Cross and Blue Shield seem consistent for both on and off health plans. In other words, when I searched for providers on either the Blue Cross or Blue Shield online tool the same number of doctors displayed regardless of whether I chose an on or off exchange plan for the location. That was not the case for Health Net in 2014.
Coverage and providers down, rates up
For 2015, it appears that the Health Net EPO and HSP plans will have the same number of doctors in-network whether the plan is purchase through Covered California or off-exchange. It’s unfortunate that the Health Net EPO has upwards of 50% fewer doctors than their PPO plans. The coverage benefits have already been reduced since EPO plans offer no out-of-network coverage. Health Net EPO plan members will see their premiums increase over their original PPO plans, have reduced benefits and have fewer in-network physicians to see for health care services.
New confusion over network doctors
Undoubtedly, the schism between the old Health Net PPO plan, new PPO off-exchange plans and new EPO and HSP will cause confusion amongst providers and consumers. With luck all the physicians will follow the Covered California – CMA recommendations to know which plans they accept and readily make that information available to their patients. There has been considerable confusion about the networks. Doctors shoulder a large share of blame by not understanding who they were contracted with and communicating that to patients. Perhaps everyone will be more educated in 2014.
Covered California Press Release – December 2, 2014
Doctors Say New Coverage Is Changing Lives
LOS ANGELES, Calif. — Covered California, the California Medical Association and leaders of 13 physician, pharmacist, hospital and health care provider groups joined forces Tuesday at the Ronald Reagan UCLA Medical Center to highlight health care being delivered as a result of the Patient Protection and Affordable Care Act and to announce a new partnership promoting health coverage offered during open enrollment.
“The voices of physicians and other health professionals are very powerful in our campaign to ensure all Californians have health insurance,” said Covered California Executive Director Peter V. Lee. “We are very pleased to join with them today to promote the importance of coverage that can mean patients can get the vital care they need.”
Lee appeared with leaders of the California Medical Association and UCLA Health System, as well as physicians who shared stories of life-changing health care they have provided to patients who obtained health coverage as a result of the Affordable Care Act.
“We physicians serving the needs of California’s vulnerable populations know how the lack of coverage for medical care can impede access, often with avoidably tragic consequences. Covered California is an important step in the direction of filling this need,” said Dr. Luther Cobb, California Medical Association president. “We’re proud to join with Covered California to raise awareness about open enrollment in physicians’ offices, through social media and in communities across the state to encourage all Californians to get the health coverage they need.”
The California Medical Association is one of 14 statewide health provider organizations that have begun sending letters to their members along with resource materials encouraging them to promote open enrollment and to display an “I’m In” placard so that patients, prospective patients and family members will know that the providers accept insurance plan products offered through Covered California.
Download press release documents at end of blog post
Across the participating groups, more than 100,000 physicians, pharmacists and physician assistants, as well as more than 400 hospitals, health systems and medical groups, will receive these materials to get the word out and leave no Californian behind during this year’s open-enrollment period, Nov. 15, 2014, to Feb. 15, 2015.
“This is the largest effort of its kind in the nation to partner with leading physician organizations to promote enrollment,” Lee said.
Dr. David T. Feinberg, president of UCLA Health System and CEO of the UCLA Hospital System, opened the event announcing these activities and used the opportunity to highlight the many patients with Covered California health insurance who have been accessing vital services through physicians and facilities in the UCLA Health System.
“In the last year, we have provided critically important health care to thousands of patients who have health insurance through Covered California,” Feinberg said. “We have seen lives saved and transformed as a result of the health care delivered here — all because of new insurance available through Covered California and as a result of the coverage expansion of the Affordable Care Act. We’re pleased to help spread the word today about the vital importance of getting health insurance.”
For more information about the care provided at UCLA to patients with health insurance through Covered California, see “OneHospital’s Story — Delivering on the Promise of Care” online at www.CoveredCA.com/news/PDFs/story-of-one-hospital.pdf.
“Ronald Reagan Medical Center is one of the 403 hospitals across California — representing 87 percent of all of California’s acute care hospitals — that are delivering on the promise of care,” Lee said. “Any Californian who does not have health insurance should take steps to purchase coverage before Feb. 15 so they will have access to medical care that can improve or even save their life.”
Joining in the effort with Covered California and the California Medical Association are leaders of the California Academy of Family Physicians, the National Medical Association, the National Council of Asian Pacific Islander Physicians, the California Latino Medical Association, the National Hispanic Medical Association, the American Academy of Pediatrics (California), the American College of Physicians (California chapter), the Osteopathic Physicians and Surgeons of California, the California Academy of Physician Assistants, the California Pharmacists Association, the California Society of Health-System Pharmacists, the California Association of Physician Groups and the California Hospital Association.
The UCLA Health System will be among the first to promote the Covered California “I’m In” message in medical offices to foster enrollment by getting the word out, through its 152 outpatient sites in Los Angeles, Orange and Ventura counties.
Californians who need health insurance should explore their options by visiting CoveredCA.com. They can apply online or seek help from more than 28,000 Certified Insurance Agents, Certified Enrollment Counselors and county eligibility workers who stand ready to help them enroll confidentially and at no cost
Lee said that plans offered through Covered California provide good access to the care consumers need from physicians throughout California.
“We want consumers to know there is broad access to physicians and hospitals across the plans offered by the exchange,” Lee said. “More than 61,000 unique physicians are available — or more than 75 percent of all licensed, active non-hospital physicians.”
Covered California plans also include access to 403 acute care hospitals, or 87 percent of such facilities in California. Covered California plans include all of the University of California’s hospitals and all member hospitals of the California Children’s Hospital Association. See “Who’s In CoveredCalifornia” online at www.CoveredCA.com/news/PDFs/who-is-in.pdf for more information.
“Today’s stories about care being delivered at one of the nation’s premiere health centers is further proof that getting coverage can get Californians access to the very best care,” Lee said.
“While the Affordable Care Act is historic and a huge expansion of coverage, there remain more than 3.2 million uninsured Californians eligible for insurance,” Lee said. “This year, the open-enrollment period will be shorter, so it’s important to spread the word quickly to uninsured people eligible for coverage about this potentially life-saving opportunity.”
BELOW IS THE BODY OF A JOINT LETTER THAT THE ASSOCIATIONS AND
PETER V. LEE, EXECUTIVE DIRECTOR OF COVERED CALIFORNIA ARE SENDING
TO MEMBER PHYSICIANS AND OTHER MEDICAL SPECIALISTS.
For a copy of the actual customized letter sent by each organization and co-signed, contact our media line.
Last year your organization’s members across the state were part of the biggest expansion of health insurance coverage since Medicare 50 years ago — an expansion effort led by Covered California. California truly did make history — reducing the number of uninsured in our state by 3.4 million and reducing the rate of uninsured from 22 percent to 11 percent (the largest decrease in the nation).
You play a vital leadership role in communicating with patients about health care issues. Because of that, your organization and Covered California are reaching out to ask you to help ensure that every one of your patients and their friends and families understand their access to affordable, quality health coverage. While the Affordable Care Act is historic and a huge expansion of coverage, there remain more than 3.2 million uninsured Californians eligible for insurance.
This year, the open-enrollment period will be brief — it began Nov. 15 and ends Feb. 5Once again, it is important news for people who can’t afford coverage today or who have been denied because of a pre-existing medical condition. Please be active in spreading the word. Remind your patients and other folks you know who don’t have health care coverage that now is their opportunity to get the security and peace of mind that comes from being insured, whether it is through Covered California, through Medi- Cal or without financial help on the individual market.
Here’s how you can help:
1. Make all your patients aware that enrollment for Covered California is open now and ends Feb. 15, 2015, and to get insurance that takes effect on Jan. 1, they need to
purchase insurance by Dec. 15. The attached PDFs provide valuable and ready-touse information you can share with your patients. Included in that material is a simple one-page document that you can share with your staff and patients that describes open enrollment. Another PDF shows which plans are offered in each county. If you have any uncertainty regarding the specific plans or products you are participating in, you can use the attached list of plan contacts regarding network status. Call or email the plans directly to confirm your status.
2. If you have a confirmed contract with a Covered California plan to serve the individual market, consider displaying the attached Covered California “I’m In” placard prominently in your office so patients know you are participating. We know there was far too much confusion last year and want to make sure that physicians, office staff and patients understand the networks and health plans with which you contract. Again, ensure that you have verified your contracting status with the Covered California plans (see #1 above) if you are at all unclear.
3. Help us identify any specific patients you have who have been helped already by having coverage through Covered California and are receiving care in your practice. We continue to collect these real-world stories, which are the best way to tell the story of coverage and care. Send information about stories you are willing to share to
James.Scullary@covered.ca.gov.
You and Covered California share the view that the Affordable Care Act is not just about getting people enrolled for coverage; it’s about making sure patients get the care they need. Enrollment is just the start. The finish line is to ensure that people who enroll get the quality care they need and deserve. We know that the initial launch was rocky in some areas and that some of the health plans need to improve their communication with both patients and physicians. We are committed to working together to make sure provider directories are accurate, networks are adequate and consumers and those they depend on — the physicians providing their care — get clear and accurate information. While it is far from perfect, we believe that Covered California is succeeding in connecting Californians with coverage, and, with your continued support, we’re looking forward to helping even more Californians in the months and years to come.
Again we want to thank you for all that you have done and ask you to help us continue our success during this important new health care era. We know that in many ways this year will be harder. There will continue to be bumps along the way. We are committed to dealing with these challenges quickly, however, because we know the difference coverage can make in the lives of the Californians we are seeking to serve.
[wpfilebase tag=browser id=58 /]