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California health insurance  -  Health Reform Questions  -  Can I Keep My Doctor?


Can I Keep My California Doctor?



UPDATE:  Please see our Definitive Guide to the California Health Networks including Covered California Changes HERE

Although not on many people's radar when discussing effects of the Health Reform law, this simple question may come back to be the biggest of them all.  We wrote about this over a year ago and now we're actually seeing the results of what we forecasted to our visitors back in the Stone Age of reform roll-out (2012).  Let's look at what you can expect from the simple question, "Can I keep my doctor"?

The Big Squeeze

The Health Reform law was drafted so that there is pressure on cost containment both at the top and at the bottom.  The law mandated a certain level of fairly robust benefits relative to prior plans (the bottom) and caps both real and political on premiums (the top).   The law, however, did not do much to actually contain the usage and cost of health care.  So where will that pressure go?  To the providers as we estimated before.  That's exactly what is happening but what's the impact on you, the California health insurance shopper?

Narrow as She Goes - the New California Health Provider Network

We're getting information on the new carrier provider networks and it's not pretty.  The new Exchange plans on the Individual/family market (Group will be larger) are expected to shrink as much as 30% on the physician side and 20% on the hospital side.  This may bring the PPO networks in line with old HMO networks.  Some carriers may shrink their networks even further below the 50% mark in order to offer lower pricing.  We might even see exclusive contracts between carriers and hospital chains which is unheard of in the California health market.  Perhaps the UC's are with Anthem.  Sutter is with Blue Shield.  Scripps is Blue Shield.  Sharp is Anthem.  This changes everything when it comes to choosing a California health plan . Now, the doctor/hospital choice comes front and center when choosing a health plan.

What To Expect From the New California Networks

This is going to be tricky.  First, we see the EPO (Exclusive Provider Organization) make it's debut again.  You have no benefits outside the EPO network unless in a true emergency.  You may also not have the Blue Card network.  Let's understand what is really happening with a narrow network.  Essentially, these are the doctors/hospitals that are willing to take a significant reduction in reimbursements from the carriers.  If cost is a proxy, they're not going to be the most sought after doctors.  There, we said it.  Now, this more narrow sliver of providers is expected to take on a huge influx in new patients, some of them with significant health issues (guaranteed issue coverage).  A doctor cannot "scale up" as there are only so many hours in a day.  We're concerned. 

The New Rules For Choosing a California Health Plan

Starting October 1st, 2013, we will be able to quote and compare the new Exchange and non-Exchange health plans as well as check out their provider lists.  In past years, the doctor networks were very expansive and pretty comparable between the major carriers.  This was even more true for the hospitals.  That's no longer the case.  We need to research our desired hospitals and doctors before making a decision now.   This network issue also figures prominently in any decision to forego a Grandfathered health plan or group coverage where the networks will likely be much broader than what's newly available. 

These are all complicated issues facing Californians and their decision of health insurance.  Please use us as a resource to go over your particular situation since there are so many different variables.  Our service is no cost to you and the rates through us are the best available (by law) that you can find on the market (even direct).  Our experience and unbiased guidance will give you the advantage and peace of mind when choosing a health plan.

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