“Pay No Attention to the Man behind the Curtain”

The government, this time the State of California, has decided that maybe it should ensure that the plans it has been selling to unsuspecting the general public will be accepted by the patient’s choice of physicians.

“A little too little a little too late,” but I digress.

So they came up with a brilliant plan to find out if doctors are taking the insurance by setting up “secret shoppers” to check the provider networks. Seems like I have heard this song and dance before:

“U.S. Plans Stealth Survey on Access to Doctors.” The article discusses how the United States Government is going to use mystery shopping techniques to assess the wait times for new patients to get into a primary care physician’s office"

But that was then (June of 2011, almost 3 years ago), and this is now:

“The secret shoppers would call or visit the providers in a plan provider directory and see whether the providers would take new patients with coverage from that plan, or whether the providers would let patients use that plan to pay for care.”

This is the latest rocket surgery dreamt up by the Covered California folks, who appear to have learned nothing from previous experience.

The short answer is that, IF the doctor is contracted with the insurance plan, then YES the doctor will see the patient and accept payment. IF the doctor is not contracted with the insurance plan and IF the patient agrees to pay the doctor, then YES the doctor will see the patient.

But, it appears that the problem is not the doctors seeing patients, but a “narrow provider network.”

So in answer to the first IF, it seems that there are not enough doctors in the network. So move to the second IF: if not in-network, then will the patient pay and accept it being applied to the out-of-network deductible? Let’s look at the article for an answer:

“Priscilla Myrick, a Berkeley, Calif., activist and plan enrollee, wrote to the board to say she was surprised to find  her providers are no longer in her  network, even though she replaced a pre-PPACA plan with a plan from the same carrier. She said her plan issuer increases the deductible to $20,000 for out-of-network, from $10,000 for in-network care, and increases the annual out-of-pocket maximum going to $12,700, from $6,350.”

It seems that Ms. Myrick's out-of-network deductible is a little high - like stratosphere high - which can be a detriment to seeing her provider.

“If you like your doctor, if you like your insurance company….”

So it seems that the insurance plans have incredibly high deductibles, a narrow physician network, and the reason that patients cannot find doctors is ... drum roll please ... the doctor’s fault. And when you cut off all legs of a frog and yell jump, the frog goes deaf.