Insurance Fraud, Covered California Edition

Comment: If a private vendor sold you a plan with a fraudulent list of services and providers, chances are you’d have an excellent lawsuit against them and someone would be losing their license, or going to jail.

“Patients thought their health providers were participating in specific plans because their names appeared on lists that Covered California, the state’s health benefit exchange, made available on its website.”

“But the lists were filled with errors, so Covered California took them off-line last month.”

[...] “Some of the biggest doctor groups in Fresno have opted not to participate in plans offered through the state exchange, saying the reimbursement is too low…. “We would be paying to see patients, and we just couldn’t afford to do that,” said Dr. Karl Van Gundy, a pulmonologist and president of the board of directors for the group [...]”

“Sharon Wilson, 60, of Visalia, thought she had found a good deal with an Anthem Blue Cross plan that cost her about $200 a month after a government subsidy. But she wound up in tears when she learned her doctors wouldn’t take her new insurance card.”

” “If it has a little Covered California sticker on it, and you take it to the doctor’s office, they almost throw it back at you,” she said.”

[...]” “Patients are not aware that they’re paying more money and they have a limited network now, a limited formulary and less benefits,” Cordova said.” (emphasis added)

Some Fresno doctors rejecting Affordable Care plans
By Barbara Anderson
The Fresno Bee
March 15, 2014

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