Health insurers may face tougher rules on Obamacare doctor lists

California insurers may face new rules on Obamacare doctor lists after state probe

In response to complaints about Obamacare doctor networks, a California lawmaker and three consumer groups are seeking legislation that would require health plans to improve provider directories.

State Sen. Ed Hernandez (D-West Covina) said Friday he introduced legislation that would force health plans to update their provider lists weekly and make them more widely available online to insurance shoppers.

The proposal, SB 137, would require insurers to post online whether doctors are accepting new patients as well as details on what languages are spoken.

The proposed legislation also calls on state regulators to craft a standard format for directories to make the information simpler to use.

"In a world where we compel people to purchase health insurance," Hernandez said, "we must empower consumers to make accurate and informed decisions about the plans and policies they are choosing."

A health insurance trade group said companies are willing to work with lawmakers on the issue, but they noted that medical providers play a major role in giving patients accurate information.

"Health plans and providers have a shared responsibility in ensuring directories are updated in a timely manner," said Charles Bacchi, president of the California Assn. of Health Plans. "We look forward to working with Sen. Hernandez on his bill."

The rollout of Obamacare in California was marred by consumer frustration over limited networks and the inability of many people to find a doctor who accepted their policy.

In November, the California Department of Managed Health Care weighed in and said two major insurers had violated state law by overstating the number of doctors available to patients.

More than 25% of physicians listed by Anthem Blue Cross and Blue Shield of California weren't taking Covered California patients or were no longer at the location listed by the companies, according to the state.

In some cases, these errors led to big unforeseen medical bills when patients unwittingly ventured to out-of-network doctors for medical tests or a surgery.

The Covered California exchange had vowed to address this issue before enrollment began.

It created a comprehensive provider directory when health-law coverage launched in the fall of 2013. But the health plan information it collected was rife with errors, and the exchange pulled the directory.

The Times made public-records requests and in September published a doctor database for consumers looking at 2015 plans.

Consumer advocates say existing state law on provider directories was written during the time of paper booklets, and it hasn't kept up with the demands of online shoppers.

"We don't allow other products to be sold with an inaccurate listing of ingredients," said Anthony Wright, executive director of Health Access, a consumer advocacy group co-sponsoring the bill.

"We can't have consumers spending significant dollars on premiums for plans with inaccurate listings of their providers," Wright added.

Anthem and Blue Shield, the top two insurers in Covered California by enrollment, have disputed many of the regulators' conclusions.

They have pointed out that physicians and their office staff frequently gave patients the wrong information, and they have contacted providers numerous times to clear up confusion.

The second open enrollment under the Affordable Care Act runs through Feb. 15.

Twitter: @chadterhune

Copyright © 2016, Los Angeles Times