Covered California unplugs most top hospitals from patients

Covered California unplugs most top hospitals from patients

Obamacare fix, beeler, cagle, Nov. 26, 2013

President Obama has been claiming that people can keep their favorite doctors under the Affordable Care Act. But anyone who wants a premier hospital in California better do some homework before signing up.

A survey of the state’s top hospitals has revealed that most contract with only one or two insurance companies under Obamacare, even though the Covered California exchange has 11 companies to choose from. And one hospital, Loma Linda University Medical Center, has refused to participate altogether and has no contracts.

Obamacare is driven by low-cost policies. So the reimbursement rate that hospitals will receive from insurance companies just isn’t worth it to them. The end result is that the blue ribbon hospitals won’t have a large presence on the exchange, CalWatchdog.com has learned.

“The more we are learn about the insurance plans on Covered California, the more it becomes clear that the big name hospitals are sitting on the sidelines — some by choice, other by design of the insurers,” said Josh Archambault, senior fellow for the Foundation for Government Accountability and a frequent Obamacare critic. “Consumers get the short end of the stick.”

CalWatchdog.com looked at the top 15 California hospitals listed in U.S. News & World Report’s 2013-2014 annual report and contacted each one to determine their Obamacare insurance contracts. The full list is at the bottom of this article. We found that six hospitals only contracted with one company, another six had two companies, one hospital had none, and one hospital accepted all 12 companies at various levels. Stanford Hospital, listed as No. 2 by U.S. News, refused to respond to numerous requests for information.

For anyone keeping their old private insurance policy, most of these hospitals will still take myriad plans.

Money

The bottom line is money. And insurance companies are well aware of the costs of working with top tier hospitals, said Gail Wilensky, a board member of UnitedHealthcare and the director of the Centers for Medicare and Medicaid Services during the first Bush administration.

“Many plans … are concerned that they will be dominated by high using populations that have previously been in risk pools and wanted insurance, but couldn’t access it,” she said. “They are pressed to narrow networks to stay within the premiums.”

An investigation I wrote for Watchdog.org (no longer affiliated with CalWatchdog.com) showed that California’s hospitals were in line with the nation’s top hospitals, which had the same type of scenario. Most of the top 18 national hospitals accepted only one or two carriers.

Perhaps the biggest vote of no confidence came from No. 4-ranked Cleveland Clinic, which takes about 100 insurance plans if you have private insurance, but only Medical Mutual of Ohio under the exchange.

Los Angeles’ Cedars-Sinai Medical Center, which made U.S. News & World Report’s national list as well as California’s, took myriad insurance plans before Obamacare, but now in the Covered California exchange lists just Health Net. Shortly after Watchdog.org’s story appeared, radio stations began running frequent ads saying that not all plans were created equal on the exchange.

“Choose your plan carefully. Make sure your plan includes coverage for Cedars-Sinai Medical Center,” the ad intoned.

Many hospitals are in a wait-and-see mode, cautiously entering the exchange and then determining later whether more insurance companies will be added.

“It’s too early to tell what we will do in 2014 or years beyond as there has been more turmoil than expected and we are watching the [Obama] administration consistently introduce or change the regulations along the way,” said Chris Van Gorder, president and CEO of No. 6-rated Scripps La Jolla Hospitals and Clinics. “It’s almost impossible to know what is going to happen or how many patients will subscribe — and, accordingly, what will happen to insurance premiums purchased on the exchange or to the reimbursement to providers.”

Turmoil

And if government funding for indigent patients is reduced, that would create further financial turmoil for hospitals.

“Two of our five hospital facilities have historically received [Medicare] funding to help offset the number of indigent and government patients they care for,” Van Gorder added. “[Medicare] is supposed to be significantly reduced starting this year in exchange for more insured patients.”

So while Covered California is ahead of most states in that it lists the insurance companies on its site, the doctors and hospitals are still lacking. Prospective policy holders can check out our chart or call the medical provider to make sure they are getting what they want.

“Not having well known hospitals in-network on Covered California plans could come back to bite consumers in two ways: first, they cannot access those doctors and second, if they do, they will be stuck with a massively expensive out-of-network charge,” Archambault said.

Top Hospitals 1

Top Hospitals 2

12 comments

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  1. Queeg
    Queeg 27 November, 2013, 19:57

    Trauma care in a bowling alley could be a reality with Central Africa nurse practitioners and Soldier of Fortune magazine certified field clinics.

    Your freedoms gone doomers….kaput!

    Reply this comment
  2. Hondo
    Hondo 1 December, 2013, 20:30

    Like all of Obamacare, it is all promise and no deliver. Just say whatever gets the vote. You get to keep your doctor as long as he was a Voodoo doctor from Jamaica. We were promised a 2500$ cut and got a 3,000$ increase, on average, not counting deductibles. You get promised beds at UCLA and get a Bell Gardens strip mall motel with some chanting nut cutting the throat of a chicken next to your bed. Anyone who took a 1st year collage econ course (and passed) knew that the numbers would never add up.
    Might as well go on down to Mexico to get treated. I’m not kidding. They would never do something so stupid as the dems and Obama did.
    Hondo…….

    Reply this comment
    • Obamanator
      Obamanator 2 April, 2015, 14:21

      What no one is bringing up is supplemental insurance like Aflac that could easily accommodate those that don’t h ave insurance with at most 200 dollar monthly plans to cover the family. They pay cash which makes it more immediate its a company that has been in business since the 50’s Obama is clueless about all this
      because there is a brick between his brain and his mouth.

      Reply this comment
  3. P
    P 2 December, 2013, 13:52

    I’m a cancer patient that is losing my insurance since Aetna is no longer writing individual plans in CA. I don’t qualify for subsidies because I have no income (Of course I don’t…I’m sick) and MediCal isn’t an option because none of my doctors accept it. I can’t switch doctors because they are specialties that only specific hospitals have.

    So first, any advice? Is my only avenue to purchase an individual plan at full price?

    Second, if a hospital only accepts one insurance company, say Health Net, they would still accept insurance from other insurance companies, as long as the patient isn’t under the Covered California plans?

    Reply this comment
    • cary
      cary 7 March, 2014, 15:58

      You probably already have received your reply but if a hospital doesn’t take Covered CA plan by an insurance company they also will not take ANY individual plan by that company. They can’t discriminate. What a mesS!

      Reply this comment
  4. Ulysses Uhaul
    Ulysses Uhaul 2 December, 2013, 21:05

    CWD……..can anyone help this person? There has to be a positive alternative for him…..

    Reply this comment
  5. Larry
    Larry 5 December, 2013, 23:13

    My wife and I are in a similar situation as my wife is in the middle of cancer treatment with Loma Linda. Signa at full cost outside Obamacare seems to be our best option.
    Possibly the most outrageous is that I believe they received a $990,000 grant to train “us” how to get Obamacare?

    Reply this comment
    • Larry
      Larry 12 December, 2013, 20:46

      Well Well, Changes on both coveredca site as well as Anthem BlueCross have Loma Linda University Medical Center and my wife’s oncologist listed as providers now. There are other ways on the Covered Ca site for them to be listed as unavailable but… hopefully this works

      Reply this comment
  6. Daniel S.
    Daniel S. 20 May, 2014, 00:07

    Please consider signing the following Whitehouse.gov petition: http://wh.gov/lAR6t

    Most people find it hard to relate to the narrow network issue in individual ACA compliant plans until they actually experience the consequences. Please help if you do understand the impact of this issue.

    Reply this comment
  7. Kimberly Plummer
    Kimberly Plummer 11 June, 2014, 00:56

    I can’t believe the hospital I have gone to for years where all 3 of my kids were born and where my husband was born right here in Burbank…. Providence Saint Joseph Medical center will not take my Individual Enhanced PPO Blue Shield policy that I am paying full price for OFF the exchange (so it wouldn’t be a “subsidized” Covered California plan that providers don’t like or want to accept) and I am still left out in the cold. What is my family getting for $1200 per month! I tried to steer clear of Obamacare and we are still victims of it. It is really sad that so many doctors and hospitals are opting out. Now I can’t see any specialists at UCLA or Cedars either. What can I do to change this awful situation. I think we individuals, many who are small business owners…..(we provide jobs for 6-10 people) are the backbone of Main Street USA economy… But it is we, who are the 5 percent who are getting the worst deal.

    Reply this comment
  8. Kimberly Plummer
    Kimberly Plummer 11 June, 2014, 01:05

    Oh… By the way… I called the medical provider…. Providence Saint Joe’s before I bought my policy to make sure they took Blue Shield and their business office said Yes… As long as it was not a Covered California plan. And I thought it wasn’t since I bought it OFF Exchange but turns out I was sold a “mirrored” plan I find out later when I am tuned down…. It mirrors a Silver plan on the exchange that other people are being subsidized with for their monthly premiums.

    Reply this comment
  9. Thomas Deviller
    Thomas Deviller 3 April, 2017, 01:55

    Before buying any kind insurance – UNDERSTAND WHY YOU NEED IT.

    http://www.insurezero.com/

    Reply this comment

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