Sacramento – A survey, conducted last week by the California Medical Association (CMA), found that 80 percent of respondents were confused about their participation status in Covered California. The respondents also reported that this confusion has negatively impacted patient care.

"The state of confusion over Covered California networks needs to be addressed before the next open enrollment period, " said Richard Thorp, M.D., CMA president. “This survey shows that the mass confusion about participation status for both patients and physicians has led to patient access issues, loss of patients and has negatively impacted patient care in our state. We need to ensure that the promise of coverage is not an empty one."

CMA's survey, which resulted in an unprecedented response from over 2,300 physicians in less than two days, showed that inaccurate provider directories and health plan contract practices has made it difficult for both physicians and patients to find out who is in and out of the narrow provider networks, primarily those offered by Anthem Blue Cross and Blue Shield of California.

Notable results from the survey include the following:

• Eighty (80) percent of physicians reported confusion about their participation status in the new networks at some point;


• Fifty-five (55) percent of physicians reported difficulties in finding an in-network physician or hospital for referral of Covered California patients;


• Seventy-seven (77) percent of physicians believed that network adequacy challenges were having a potentially negative impact on patient care in their practice;


• Fifty (50) percent of those physicians participating in the new products planned to continue participating, while thirty-nine (39) percent were not sure; and  


• Fifty-one (51) percent of physicians reported losing patients as a result of the new individual and small group products.

California’s health care system is arguably undergoing its biggest period of transformation since the introduction of Medicare 50 years ago. Roughly 1.4 million Californians across the state are now covered by dozens of new health insurance products offered through the state’s health benefit exchange, Covered California, and many more are now covered under new products in the broader individual market.

Coverage, however, means little without access to health care providers. Since the new coverage became active on January 1, 2014, CMA has logged a rather steady stream of concerns and complaints from physicians regarding the networks.

“The integrity of California’s health care delivery system is being threatened by the fact that patients cannot rely on certain major health plans’ lists of participating providers and that many physicians have been or remain confused about whether or to what extent they are contracted to serve patients covered under the slew of new insurance products,” wrote Dr. Thorp in a letter to Covered California Executive Director Peter Lee.  

CMA's letter urged Lee to make improvements to the Covered California physician contracting, networks and directories prior to the start of the next open enrollment period.