Covered California patients file complaints against Blue Shield, Anthem Blue Cross

Michael Finney Image
Wednesday, February 18, 2015
Covered California patients say they can't find a doctor
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7 On Your Side investigates complaints from Covered California patients under Blue Shield and Anthem Blue Cross who say they aren't able to find a doctor.

SAN FRANCISCO (KGO) -- On Tuesday, Covered California said it did not meet its goal of signing up 1.7 million people by Sunday's midnight deadline. They were 300,000 short. And worse, thousands of people who signed up last year still can't find a doctor to care for them.

Critics claim Covered California does not have enough doctors to care for patients, and they say patients are suffering because of it.

San Francisco resident Bryan Edwards suffers from a chronic sinus infection. He points to all the spots where he feels his head pounding.

"It just feels like somebody's hitting you in the corner of your eyes with a ball-peen hammer," he said.

Edwards is one of 345 Covered California patients under Blue Shield and Anthem Blue Cross who filed complaints with the state because they couldn't find a doctor. The two companies have the most patients enrolled in Covered California.

Laura Antonini is an attorney with Consumer Watchdog. She's filed lawsuits against both companies.

"Once people were locked into their plans, suddenly the provider network shrunk, and people either couldn't go to the doctor that they wanted to go to or they couldn't even find a doctor that was in the network," Antonini said.

In November, the state released its investigation into both companies and found they provided enrollees an inaccurate list of doctors. Nearly 13 percent listed by Blue Shield as accepting Covered California patients did not actually accept them.

Anthem Blue Cross' list had the same problem, with almost 9 percent of the doctors inaccurately listed as accepting Covered California patients.

"Then there's that other issue of whether the provider networks are adequate," Antonini said. "Are there enough doctors?"

Edwards experienced this problem first hand. He saw a doctor last year listed as accepting Covered California patients, then was shocked to receive a $900 bill.

"And they said, 'oh I'm sorry, we don't take Covered California,'" Edwards explained. "And I said, 'wait a minute.'"

The San Francisco resident contested Blue Shield's decision, but lost his appeal. He took his complaint up the chain and eventually Blue Shield paid for his out of network doctor. But he still doesn't have a permanent doctor because he says he can't get an appointment.

He explained how a typical phone call goes: "'Hey, I have Blue Shield. I need to see the doctor.' And every single doctor told me, 'Wait, is it real Blue Shield or Covered California? If it's Covered California, we don't take it.'"

Blue Shield told us: "The network purchased through the Covered California exchange is somewhat smaller. But still provides access to most of the high-quality physicians offered in the standard PPO. This has involved trade-offs between choice and price point."

Anthem Blue Cross said: "We have mailed and called every doctor in our network in an effort to update the information. Our internal data shows fewer complaints on this issue."

And he's right. Those complaints did decline by the end of last year. Blue Shield went from 92 to 51. Anthem Blue Cross went from 108 complaints to 94. But Consumer Watchdog says that's not enough.

"It makes me feel outraged," Antonini said. "I mean, like I said, we're hearing from hundreds of consumers all the time and they're still dealing with this."

The Department of Managed Health Care plans to release a follow up survey in May. Investigators have referred the issue to its enforcement division.