News & Updates
October 10, 2015
The bill, introduced by state Sen. Ed Hernandez, D-West Covina, and sponsored by three statewide health advocacy and consumer groups, was proposed in response to numerous complaints by California residents who enrolled into health plans through Covered California beginning in October 2013 only to find inaccurate provider directories, no doctors in the networks chosen and other mistakes.
Among the bill’s requirement, the Department of Managed Health Care and the Department of Insurance must develop uniform provider directory standards, update directories weekly rather than the monthly federal standard and offer information on languages spoken by providers.
California consumers need to know which doctors and hospitals are in plan networks when they are choosing and using their health coverage, to keep care affordable and avoid surprise out-of-network charges,” said Betsy Imholz, special projects director for Consumers Union, the advocacy and policy arm of nonprofit Consumer Reports. “By setting uniform standards for directory elements, with frequent updates, this bill lays the groundwork for creating a consolidated statewide directory across plans for truly informed consumer choice.”
Results of a state audit on Medi-Cal released in June found that Anthem Blue Cross, Health Net and Partnership Health Plan had many errors in their directories, including incorrect telephone numbers and addresses, or information about whether they were accepting new patients.
The bill places pressure on health insurance providers by making them reimburse an enrollee who ends up paying for out-of-network service because of inaccurate information. The bill goes further, suggesting penalties if there is a lack of communication between health insurers and providers.
It would “authorize a plan or health insurer to delay payment or reimbursement owed to a provider or provider group, as specified, if the provider or provider group fails to respond to the plan’s or health insurer’s attempts to verify the provider’s or provider group’s information.”
Some physicians groups and the California Hospital Association voiced opposition to the bill, saying those penalties went too far.
But the changes were needed, especially after thousands of people who began to enroll into plans through Covered California discovered that an online directory contained many inaccuracies. Covered California, the state’s health exchange established under the Affordable Care Act, discontinued the directory in February 2014.
“The new law will make it easier for consumers shopping for health coverage to find a doctor who speaks their language or ensure their current bilingual provider is in their plan,” said Sarah de Guia, executive director of the CPEHN. “The law also strengthens consumer protections by requiring health plans to include a notice in the directory informing consumers about language assistance services. SB 137 is a critical tool for all Californians and will help improve access to care.”
Anthony Wright, executive director of Health Access California, said the new law will help consumers make better decisions.
“Just as we don’t allow grocery stores to sell food mislabeled with the wrong ingredients we shouldn’t allow insurers to sell health plans without accurate provider directories,” Wright said. “Our hope is that over time this will make the marketplaces more responsive to consumer demand for accessible, high-quality care.”