COVERED CALIFORNIA EXCHANGE PLANS DESCRIBED AS UNFAIR BUSINESS PRACTICES
Meet Harrington and Talon. Both Californians who attempted to take care of their medical needs by purchasing insurance from Blue Shield of California. Harrington purchase through Covered California, the ACA Exchange in California. He read through the many assurances that the plan had a vast network of physicians and other providers. Talon purchased through Blue Shield’s website. He likewise was assured that the plan was supported by appropriate healthcare providers.
Both Harrington and Talon have sued Blue Shield in a class action lawsuit in a California court. Both claim they had medical treatment by finding providers listed with Blue Shield. Talon said he only found out he had a Covered California plan after trying to get payments for his treatment. Blue Shield refused to pay for either Talon’s or Harrington’s treatment.
The lawsuit reflects the growing concern in California and elsewhere about the networks of physicians provided by the Exchanges. In order to keep costs down, the insurance companies have designed plans that have fewer providers who will take more patients for a reduced payment. I have had scores of doctors tell me about their attempts to provider providers under the Covered California’s plans. They are unable to find specialists to do things like set broken arms or consult on troubled pregnancies. This is compounded by the requirement that doctors make sure that make referrals that are within the networks.
The lawsuit by Harrington and Talon is just another step in the process to determine if the Accountable Care Act will function with narrow networks. Without the narrow networks, it is unclear if exchanges, which require insurance companies to insure everyone, regardless of previous conditions, can operate in an economically efficient manner.
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