Over 214,000 Doctors Opt Out of Obamacare Exchanges

[SalviaBlue]

26. I had BS (Blue Shield) Silver in CA.

I was provided with a list of providers before I chose the plan and my Doc was on it. I also called my Doc office to double check and they said yes they would accept this plan. So I purchased BS Silver. The premium was similar to what I currently paid for private coverage and similar to what Anthem charged for the Silver Covered CA plan.

In July, I called my Doc for annual ck up and they said they were NOT accepting the plan.

I went online at BS and downloaded the current list of providers and my Doc was now NOT on it. I saw a couple of other Docs I recognized and called for appointment but none of them were accepting this plan.

I registered a complaint with BS to which they never responded.

I called Covered CA and was able to work with a Resolution/Appeals specialist. We determined that most of the names on the provider list were actually not accepting BS. However, I was able to determine that my Doc and many others I checked with accept the Anthem Silver. Fortunately, CoveredCA helped me to change away from BS to Anthem mid-year.

I was told by several of the doc offices I spoke with that they were not accepting BS because the reimbursement was substantially lower for CoveredCA plans (20% lower) than the other BS plans. Anthem is apparently reimbursing the same for CoveredCA plans as non CC plans.

What ends up happening with these small networks is that you end up having to see alot of out of network docs and have to pay 50% instead of 20% and there is no cap.

In summary, yes Doctors are opting out because the insurance companies (Blue Shield in particular) are playing games with networks and doing everything they can to screw providers and patients.