Rep. Huffman Applauds California Regulators for Investigating Anthem Blue Cross, Blue Shield for Misleading Provider Networks

November 20, 2014

WASHINGTON—Congressman Jared Huffman (D-San Rafael) today applauded the California Department of Managed Health Care (DMHC) for finding Anthem Blue Cross and Blue Shield of California in violation of state law for drastically overstating the availability of health providers on their new Affordable Care Act policies. According to the DMHC report, more than 25% of physicians listed by Anthem Blue Cross and Blue Shield of California were not taking Covered California patients or were no longer at the location listed by the companies. Anthem and Blue Shield account for nearly 60% of enrollment in Covered California, including a significant market-share in Rep. Huffman’s district.

“I have heard firsthand about the chaos and confusion created by inaccurate and misleading information on the physician networks for Anthem in the North Coast, and know that many of my constituents have been hurt by these failures,” Huffman said. “This action by DMHC brings much-needed accountability and ensures consumers that regulators are working to protect their interests.”

The report comes mere days after the three-month open enrollment period for health insurance coverage opened. Last year, 1.1 million Californians enrolled in health insurance plans under the Affordable Care Act. DMHC has not determined whether Anthem Blue Cross and Blue Shield of California will face financial or legal penalties for its violations.

The DMHC report on Blue Shield of California can be found HERE, and the report on Anthem Blue Cross can be found HERE.

According to the DMHC survey:

A significant percentage (12.5%) of the physicians listed in the Anthem Blue Cross directory were not at the location listed in the Provider Directory and that a significant percentage (12.8%) were not willing to accept patients enrolled in the Plan’s Covered California products, despite being listed on the website as doing so.
A significant percentage (18.2%) of the physicians listed in the Blue Shield directory were not at the location listed in the Provider Directory and that a significant percentage (8.8%) were not willing to accept members enrolled in the Blue Shield’s Covered California products, despite being listed on the website as doing so.

This June, Huffman wrote a letter to Mark Morgan, Anthem Blue Cross President, California Commercial Business criticizing them for their misrepresentation of plans, lack of transparency, and failure to provide adequate networks to his Northern California constituents. Huffman wrote:

June 25, 2014

Mark Morgan
President, California Commercial Business Anthem Blue Cross
1 Wellpoint Way Thousand Oaks, CA 91362

Dear Mr. Morgan,

In light of recent news that the California Department of Managed Health Care is investigating whether Anthem's inaccurate provider lists and inadequate networks violated California law, I am writing to inquire what steps Anthem is taking to address these network adequacy problems affecting current customers, and how you will be preparing for the second California exchange open enrollment period. I am deeply concerned about the apparent failures to ensure that the first enrollment period was transparent, honest, and fair for many of my constituents along the North Coast. These unresolved failures and continued inadequacies threaten the health and well-being of my constituents, the livelihood of physicians and other health care professionals, and the shared goal of ensuring successful implementation of the Affordable Care Act.

Throughout the beginning of the year, I have heard firsthand about the chaos and confusion created by inaccurate and misleading information on the physician networks for Anthem in the North Coast. Many signed up for plans believing that their local physician would continue to be in-network, only to discover that the original lists of in-network physicians was wrong. This puts my constituents in the position of seeking out one of the few in-network providers within the narrow networks of these policies, or face significant financial burdens for out-of-network care. Worse, some discovered this situation only after seeking medical care, receiving bills of thousands of dollars for out-of-network services while still recovering from surgery. How is Anthem addressing complaints from patients who are seeking care but received inaccurate information when they signed up for their plans? I seek your assurance that these misrepresented plans from the first open enrollment period are being fixed to your customers' satisfaction. In addition, I want to know how Anthem will ensure that there is no misinformation provided to consumers in the next open enrollment period.

Even when given truthful network information, consumers in the North Coast are facing narrow networks that exclude many of the physicians they know and trust. Recently, Anthem reported adding 3,600 new doctors to your network in California, but you have declined to comment on ongoing issues in the counties in my district. In May, your press releases focused on announcing new physicians and hospitals added to your network in Sacramento, Los Angeles, and other major metropolitan areas. Does Anthem's expansion indicate an admission that networks were too narrow and inadequate at the start? While you expand in these large urban areas, what efforts are being made to expand in the rural ones as well and ensure that consumers in these areas have quality health care coverage? Where do the communities of Marin, Sonoma, Mendocino, Humboldt, Trinity and Del Norte find additional support from these expansions? Over ninety percent of Northern California enrollees have plans from Anthem Blue Cross; failures in your network mean that an entire region of our state may be left behind in the promise of affordable, adequate health care.

I have been told by physicians on the North Coast that the low reimbursement rates you initially offered helped to cause the low rate of participation in your network. However, as you expand your networks, new physicians joining are offered more reasonable rates. I am concerned that the few physicians who accepted low initial rates are now locked into multi-year contracts that put them at a significant financial disadvantage. The result is an unjust system by which the very physicians who helped establish your networks on the exchange are now being punished. What recourse do they have when you sign new contracts with other physicians at more reasonable rates?

The Affordable Care Act was passed in response to our nation's untenable health care system, which was costly and fell far short of providing universal coverage. Despite the successes of the Affordable Care Act to date, these long-running failures will not be fixed overnight. This fall is an opportunity to assess the progress made on the road to full, universal coverage for all Americans, as new rates are published and consumers participate in a second open enrollment period. I look forward to your response explaining how Anthem is resolving the problems from the first enrollment period, and how you will take advantage of this second opportunity to address challenges facing my North Coast constituents.

Sincerely,

###

Next Article Previous Article