Exchange’s Physician Directories Removed Because of Errors

New York Times by Ian Lovett –

February 10, 2014:

The California health care exchange has taken down its physician directories, amid continuing complaints from doctors and patients alike that the lists of doctors and hospitals included in each insurance plan were error-riddled and unreliable.

Since the October rollout of Covered California, inaccuracies have posed countless problems: The lists described doctors as fluent in languages they did not speak; obstetricians were labeled as ophthalmologists; and physicians were falsely listed under insurance plans that did not cover care at their offices.

The directories were temporarily pulled from the website in October, after the exchange acknowledged there were problems with data. Revised lists were put online late last year.

But the exchange announced late Thursday that those revised lists would be removed “until further notice” because more errors were found.

“Until we know what’s causing these problems, the directories are probably better down than up,” said Jeff Rideout, a senior medical adviser for Covered California.

“These networks are very different, depending on which plan you choose,” he said. “You have to pick the right plan to get the right hospitals and providers.”

Mr. Rideout said he hoped the lists could be restored to the website, but he would not say if or when that would happen. In the meantime, people who enroll are being told to contact the individual plans to find out which providers are included in their networks. Beneficiaries have until March 31 to cancel the coverage they selected or enroll in a new health care plan.

California’s problem with physician directories is another challenge for the health care exchanges in states across the country.

In multiple states, people who signed up for coverage have had trouble proving they are covered and confirming which doctors are in their network. In Massachusetts, the governor last week that the state would pay a technology firm nearly $10 million to help fix its exchange.

Covered California continues to face criticism over wait times, upward of 50 minutes, that people face when they call the exchange. Peter V. Lee, its executive director, announced on Monday that the agency would hire at least 350 new workers to help smooth operations while demand remained high. Between October and early January, more than 625,000 people had signed up for coverage through the exchange, Covered California officials said.

Because of the “massive demand,” Mr. Lee said, many consumers “have not had the ideal experience.”

“We’re going to make sure as we go through the final two months of open enrollment that we’re there to help consumers.”

Officials with the California Medical Association, which represents thousands of doctors in the state, said that reliable information about physicians was crucial to making sure consumers would be able to gain access to the care they need, especially those who had gone without coverage and were unfamiliar with the health care system.

“The burden now falls on the patients to have to call through every plan individually,” said Molly Weedn, a spokeswoman for the association. “It’s daunting for someone who now has to call through all these individual plans and find out if their current physician or physicians in their area are contracted or not.”

Mr. Rideout of Covered California said that some problems with the provider directories stemmed from miscommunication between doctors and insurance companies, with doctors sometimes unaware that they were under contract with certain health care networks.

But Richard Thorp, the president of the California Medical Association, said that several patients had scheduled appointments at his practice in Paradise, Calif., because they had gotten bad information from the Covered California website.

Both men agreed that faulty provider lists were a longstanding problem in California health care, one that long predated the Affordable Care Act.

“There’s very little incentive for plans or physicians to keep those lists clean,” Dr. Thorp said. “So this is a massive updating effort.”