Obamacare Fail: No, Doctors Will Not Take Your Insurance

An Obamacare fail might be afoot, this time through the Covered California exchange, with regulators admitting they have no way of monitoring whether information provided from insurers is accurate regarding which doctors are actually covered as in-network.

The issue arose two months ago when KPIX 5 Consumer Watch first reported that some of the doctors listed were not actually accepting insurance purchased through the exchange.

On Monday, Anthem Blue Cross admitted that close to 1,000 doctors were erroneously listed.

The California Medical Association were recently notified by Anthem that a total of 965 physicians were wrongly placed on the exchange’s list. The notice was issued on April 9, and admitted that doctors had been “inadvertently” listed for “a certain period of time” during open enrollment.

Anthem is billing it as an honest mistake and said that the affected physicians were paid “at 100 percent of Prudent Buyer PPO rates” for services between January 1 and March 31. Service claims on or after April 1 will be reimbursed as out-of-network.

On Monday evening, Anthem issued a statement to CBS:

As we have said in the past, Anthem Blue Cross continually works to improve the accuracy of our provider directory. In the process of updating our provider database, we found that while the vast majority of the listings were correct, there were some providers inadvertently listed. Many of the doctors inadvertently listed decided to join Anthem’s network during open enrollment period anyway and overall, Anthem has added nearly 2,000 doctors to our exchange network this year statewide.

Given that the Obama administration had been claiming that this sort of thing wouldn’t happen, and the mistake just so happened to occur during the period when ACA needed enrollees the most, it won’t be long before the GOP pounces on this newest Obamacare fail in hopes of improving their odds of holding the House and overtaking the Senate in November.

They’ve certainly got a list of talking points that will need serious answers before embattled Democrats in vulnerable states are able to pass the 2014 election test. Questions such as:

How many people have paid their premiums?

What will prices be like after November once they are recalculated based on a demographic of enrollees that skews older (and are more vulnerable to medical events)?

How will the quality of care (number of medical professionals) expand to keep up with the influx of insured?

How many people have lost their plans, and how many will lose them once the delayed employer mandate kicks in?

How many other insurers have “misrepresented” the amount of doctors accepting ACA-based health insurance?

The GOP could certainly still lose out in November — at least on the Senate front — but headlines touting the success of the law are way premature. There is still much we don’t know regarding whether Obamacare will fail or succeed. Developments like the false doctor listings by Anthem do little to win public trust for the law as a whole, especially as regulators admit they have no way of monitoring for accuracy.

What do you think — will Obamacare fail, succeed, or is it too early to tell?

[Image via Flickr Creative Commons]