Is there any difference in practise the Provider Directory
for the same plan

be it direct with the Insurance Company or Covered CA?

 

Briefly, NO!!!  That’s what the law says.  

Mirrored Plans – same network & benefits in and out of Covered CA   

However, reality seems to be different.  Read more about it on our friendly competitors site 11.22.2015, 12.13.2015 update and 11.7.2016.  He writes 10x what I do.  See our enforcement page, Blue Shield just announced their settlement with DMHC and you can resubmit claims.

I have trouble using the Blue Cross – Anthem  provider finder, it’s way too complicated, so many meaningless choices.   Here’s the response from BC on why so many names of plans and networks are their, even though they are exactly the same –

Pathway is the same on and off the exchange. We are required by Covered CA to list it as Pathway X on provider finder.  ^{Email dated 11.17.2015}

A newly released study found that 4.38% of Covered California policyholders enrolled in Blue Shield or Blue Cross plans were rejected by doctors who were supposedly accepting their insurance, compared with 1.41% for people with the same plans purchased outside the exchange.  Learn More ==> LA Times 7.27.2016

Related pages in Provider – Doctor & Hospital Finder » Narrow Lists? Fewer MD’s than before?  Section

• Covered CA vs Direct Provider Lists? Q & A

 

Comments

Here’s comments and research by one of our clients with Blue Cross (BC) in Covered CA (CC).   We’ve notified BC and CC of the first email, but don’t want to upset them by sending too many emails… BC did send us an email on 12.18.2015 that they would have their contracting dept. look into this.

this link states that john muir health  (the drs I mentioned are all part of john muir health) will only take covered california blue shield or health net (but some of them dont as I mentioned)

covered california.john muir health.com

If you go to their website and to their find a dr  link          john muir health.com

you find the two offices I mentioned (richard chang and the individual drs that comprise muir orthopedic specialists. Those physicians list Anthem as one of their providers but in reality they wont take any covered california plans including blue shield covered ca which the group states on line that they take.

As I mentioned earlier when I called the billing department for the whole group I was told its up to the individual drs office to take covered ca or not This group has a huge percentage of the drs in this area (concord, pleasant hill, walnut creek, and much of east contra costa county

In the end the cost of health insurance has gotten so out of control that its still worth it, but its very difficult to make decisions about who to choose under covered ca because you dont really know what you are getting.

Sorry to keep bothering you about it

Thanks for forwarding the info to anthem

The last link is for my gp, he is not listed as a provider on anthem’s list. the first two are the ones I got a definite no from. Dr Richard Chang and Muir orthopedics

if you call them as if you are a patient you will find what I said is true. they apparently don’t take any covered California regardless of which plan it is.

My primary care dr would like to take it but they dont include them as a provider although they are part of the john muir network, I think anthem does pay for them if they are not covered ca though but not positive. Ive been self paying them for two years because of this.

John Muir physicians group

2700 grant ave

concord, ca

Dr Richard Chang, Cardiology

1450 Treat Blvd
Suite 220b
Walnut Creek, CA 94597

Phone: (925) 937-1770

just called yesterday and again today. they said they take no covered california plans but they take athem and blue shield non covered ca

.muir ortho.com/

same story with them

john muir health.com

if you look on the john muir group they say they take covered ca. I called them after those two offices mentioned above said they dont take covered ca and they told me that its up to each individual drs office in their group

I am not sure if its the provider who is unwilling to take covered ca or if its the insurance company who is unwilling to pay them what they normally get. From what I can see the insurance company gets the same amount of money with the subsidy as they do with non covered california plans so I dont really get why its a problem.

I looked at the provider list from covered ca link and call some of the providers and they tell me that they dont take the covered ca from anthem or blue shield but will take the non covered ca plans.