Kevin Knauss: Health, History, Travel, Insurance
Posts related to provider networks of health plans: doctors, hospitals, labs, physical therapist, counselors, psychologists.
But if you don’t have an account, are trying to help a family member or friend, or are just checking to see if you current mental health provider might be covered in a new health plan, you will have to swim in the sea of confusion for finding the doctor or counselor. Some of the health plans have great online directories and others really suck. Here is an overview of what I learned.
The California Department of Health Care released a report confirming that several health plans may have had inaccurate provider directories for their member to search through. The Timely Access Report year 2015 reviewed several different measurements to determine if health plan members could obtain timely access to health care services. The report noted that 13 health plans listed Primary Care Physicians who were not in the health plan’s provider network.
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.
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 […]
The federal government is reaching out to behavioral health counselors and therapist to educate them on how the Affordable Care Act works so they can encourage members of the LGBT community to enroll in an ACA health plans. Sometimes the professionals who provide important health services through health plans offered through Healthcare.gov and CoveredCa.com can be the […]
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 […]
The first challenges individuals and families faced with the smaller provider networks offered in California was keeping their current physician or finding doctors that would accept the new health plans for health care treatment. The next hurdle has been doctors referring or using out of network physicians for patient care. Patients are now getting slapped […]
Now that you, your children or your entire family are now enrolled in Medi-Cal, the next challenge is finding a doctor. Virtually all of the Medi-Cal plans will be HMOs (Health Maintenance Organizations) where you will have to select a primary care physician (PCP). Your PCP will be your initial contact point for referrals to other health care services he or she may not be able to perform in their office.
Consumers looking to select a new affordable Care Act health plan will have to carefully consider the benefits and limitations of the different provider networks associated with each plan. In addition to the familiar PPO and HMO designs, many carriers have added the EPO. Which network is best for your family?
Open enrollment for the new Covered California health plans launches October 1st. But you don’t have to rush into unknown waters and sign up for coverage that doesn’t start until January 1, 2014. Because these health plans are new, it would be prudent to avoid immediately enrolling until the health plans have been reviewed and all the details are known.
