November 01, 2013
Area(s) of Interest: Advocacy Health Care Reform
Covered California briefly launched the long-awaited online provider search function on Monday, October 7, only to take it down on Friday, October 10, due to inaccuracies and slow performance. When the search was first launched, the California Medical Association (CMA) performed a few test searches and noted inaccuracies with some specialty designations, participation status and languages spoken.
The provider search function was back online by October 22; however, the only “fix” appears to be that Covered California removed the specialty designations completely, with that field now reflecting “not provided.” Information on languages spoken and participation status on some physicians remain inaccurate.
The search function allows patients to determine if a particular physician is contracted with any of the participating health plans. Though aimed at patients, physicians can also use the search to determine which plans list them on their exchange provider directories. CMA encourages physicians to review their status with plans offered in their area to determine whether they are showing as participating or non-participating.
The provider search is available through Covered California’s “Preview Plans” tool. To access the search:Visit www.CoveredCA.com and click on the “Apply Now” button near the center of the screen.
Next, select the “Preview Plans” tab at the top of the next screen.
The user will then be directed to provide some general demographic information and click “See My Results” at the bottom right.
Click “Preview Plans” again on the next page, then select the “Find Your Doctor or Hospital” bar in the middle of the screen, which opens a dropdown box with both “Find Your Doctor” and “Find Your Hospital” options.
Select the “Find Your Doctor” option, and input the physician's name and location. If the desired physician is contracted with a participating Covered California health plan, his or her name should appear in the subsequent provider list.
Select the desired name from the list and choose the “Add to My Providers List” option. If you would like to search for another physician, click "Find Your Doctor" again and repeat the process. Once your list is complete, select “Choose a Plan.” The plans in which the chosen physician(s) participate will show a green checkmark box in the “My Doctors” row within the summary at the lower half of the page. A red minus-sign box indicates that the physician does participate in the plan.
Covered California had also promised the ability to download copies of provider directories furnished by qualified health plans via Covered California’s website. This option does not appear to be available yet on the www.CoveredCA.com website.
Both provider and patient advocates have been eager to know which providers are being included in the exchange network. Providers’ interest has been stoked by the general ambiguity with which some health plans have conducted their provider contracting, such as failing to identify products as exchange products and using “all products” or “all affiliates” clauses to include physicians in an exchange network.
If you find that you are being identified as contracted with an exchange plan but did not intend to do so, contact the appropriate provider relations representative at the health plan and CMA’s Center for Economic Services at firstname.lastname@example.org or (800) 786-4262.
CMA will continue to monitor the implementation of the Covered California provider directories and keep readers informed of any significant developments.