California regulators probing complaints against Anthem Blue Cross, Blue Shield


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LOS ANGELES — California regulators are investigating whether Anthem Blue Cross and Blue Shield of California misled consumers about which doctors they covered under federal health care reform packages.

The California Department of Managed Care is trying to determine whether state laws were violated in the way the medical insurance giants enacted new, limited health coverage networks under the Affordable Care Act, the Los Angeles Times (http://lat.ms/1lRMe9Q) reported.

"Our preliminary investigation gave us good cause to believe there are violations of the law," agency spokeswoman Marta Green said.

Patients have complained that they were erroneously told that certain medical providers were included in the smaller networks, and they used that information to choose a health plan through Covered California, the state's health insurance exchange.

Other patients said they received treatment only to find out later that the doctor wasn't considered part of their health plan network.

More than 200 complaints have been filed against the two companies this year.

"Anthem and Blue Shield have led the pack on these network and provider issues," Green said.

"Anthem Blue Cross continually works to improve the accuracy of our provider directory," spokesman Darrel Ng said. "In the process of updating our provider database earlier in the year, we found that while the vast majority of the listings were correct, there were some providers inadvertently listed."

More than 3,800 medical providers have been added to Anthem's statewide exchange network since January, the company said.

Blue Shield said it also has added more doctors and hospitals.

"We are redoubling our efforts to inform physicians and our customers as to what the network makeup is," spokesman Steve Shivinsky said. "If some corrective action is necessary as a result of the state survey, we will do that."

The two companies together grabbed nearly 60 percent of the 1.4 million people who signed up for private health insurance through Covered California in the first enrollment period.

The next open enrollment period begins in November.


Information from: Los Angeles Times, http://www.latimes.com

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