Access to providers and accuracy of information about provider networks is lacking for some health plans sold through Covered California and in the private market, according to a new study published in Health Affairs.
In the study, "secret shoppers" posing as patients found they could schedule an appointment with an initially selected physician less than 30 percent of the time, and information about provider networks was often inaccurate.
The callers contacted 743 primary care providers from five of California's 19 insurance marketplace pricing regions in June and July of 2015. In each of the five regions, researchers randomly selected at least 70 primary care providers who were listed in the insurers' directories as accepting new patients in both marketplace and non–marketplace plan networks from Blue Shield of California and Anthem Blue Cross.
In about 10 percent of cases, the providers listed in the respective directory either were no longer with the group listed or had never been with the group at all, the study found.
Additionally, in about 30 percent of the cases the specialty listed in the provider directory did not match the one stated by the receptionist at the practice.
Researchers said they also were unable to contact 19 percent of providers of non-marketplace plans and 18 percent of providers of marketplace plans at the telephone number listed in the directory because the line was disconnected, three messages were not returned, the wrong number was given or the line was constantly busy. Ten percent of providers listed in the non-marketplace directories did not accept any new patients, according to the study. The same was true for providers listed in marketplace directories.
"As our analysis has shown," the study concludes, "access to health insurance is not necessarily synonymous with access to healthcare services."
Both insurers told California Healthline they are making efforts to fix their directories. Covered California spokeswoman Lizelda Lopez also noted to the publication that a new California law requires insurers to update their online directories once a week and their printed ones each quarter.
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