Two Covered California health insurance plans misled consumers, regulators say

The San Jose Mercury News reports:

Two major health insurers selling policies on the Covered California insurance exchange violated state law over the last year when they listed names of doctors in online directories who were not part of their networks.

Results of a five-month-long investigation into the practices of Blue Shield of California and Anthem Blue Cross of California by the Department of Managed Health Care released Tuesday revealed that:

Eighteen percent of the physicians listed by Blue Shield were not at the location listed in the provider directory. Of those who were listed, 8.8 percent were not willing to accept members enrolled in Blue Shield's exchange products.

Twelve and a half percent of the physicians listed by Anthem were not at the location listed in the provider directory. Of those who were listed, 12.8 percent were not willing to accept patients enrolled in Anthem's Covered California products.

Department spokesman Rodger Butler said the results have been referred to the department's Office of Enforcement for corrective action and possible financial penalties. The department also plans to do a follow-up survey in six months to ensure that the companies are complying with the Knox Keene Act, which regulates health care plans in California.

Since January, when the new plans under the nation's health care law took effect, widespread consumer outrage over the inaccurate lists led to dozens of Blue Cross and Blue Shield customers filing complaints with the state.

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