New data reveal the biggest category of complaints centers on getting confirmation of health plan enrollment and basic issues such as getting an identification card to obtain care.
Many consumers have also encountered difficulty finding a doctor who accepts their new coverage, as well as frustration with inaccurate provider lists, according to the California Department of Managed Health Care.
“If you have a medical condition and can’t get care that is a very serious issue,” said Marta Green, spokeswoman for the managed healthcare agency. “We are still working to resolve many of these cases.”
Health insurers and officials at the Covered California exchange say they are working hard too to address consumers’ gripes. They say some problems are inevitable from such a massive overhaul and that the number of complaints is a small fraction of the more than 1 million Californians who signed up under the Affordable Care Act.
Consumer frustration with smaller physician networks has drawn the most attention statewide.
About 12% of the 1,459 exchange customers who complained to the state cited an access to care problem, according to state figures. The data cover complaints received from Jan. 1 to April 30.
Not surprisingly, Green said, the two largest health plans in Covered California accounted for the most complaints overall and in the category of access to providers.
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Covered California’s executive director, Peter Lee, announced a special enrollment period Thursday for an estimated 300,000 people with COBRA health coverage. (Rich Pedroncelli / Associated Press)
Anthem Blue Cross, a unit of industry giant WellPoint Inc., received 658 complaints through April and nearly 13% dealt with provider issues, state data show.
Blue Shield of California was next with 461 complaints and 17% focused on finding an in-network doctor.
Peter Lee, the exchange’s executive director, said, “[T]hese complaints are one indicator we are looking at for the scale and scope of the problem …. We want to ensure the networks are adequate.”
At an exchange meeting Thursday, Covered California credited some insurers for expanding their networks to better serve higher-than-expected enrollment.
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For instance, Health Net Inc. said it boosted the number of doctors in its exchange HMO plan by 68% since Jan. 1 to 11,600.
Anthem said it has added more than 3,800 medical providers to its statewide exchange network since January, including well-known hospitals such as Cedars-Sinai Medical Center.
Blue Shield said its PPO network for individual coverage has grown to include 62% of physicians and more than 80% of hospitals on its standard PPO roster.
Industry officials point out that many consumers welcome the lower premiums a narrower network can offer.
“Some networks are very broad and others are more selective — giving consumers the option of choosing a plan that may have fewer providers but costs less in monthly premiums,” said Charles Bacchi, executive vice president at the California Assn. of Health Plans.
Covered California said health plans will submit proposed rates for 2015 in the next week. The state expects to announce the new premiums in late July after negotiating with insurers.
The exchange estimates that its enrollment from the recently completed six-month sign-up period will be about 1.2 million, assuming 85% of consumers pay their premiums.
A new forecast predicts Covered California enrollment will reach 1.7 million after 2015 open enrollment and hit 2 million by 2016.