Blue Shield exchange/off-exchange plans leading to confusion among physicians The California Medical Association (CMA) has seen a large increase in calls from physicians confused about the plans/products offered by Blue Shield both on and off the exchange. As you may know, federal law requires that every plan offered in the exchange also be offered off the exchange, using the same network. This has resulted in a number of practices unknowingly seeing patients out-of-network for products that use the insurer's narrower exchange network. It has also created an additional level of confusion for physician practices when checking patients' coverage status. In the case of Blue Shield, the insurer offers 12 separate products linked to its exchange network, which it calls the "Exclusive PPO Network" or "Exclusive EPO Network." These products, whether purchased on or off the exchange utilize the Blue Shield "Exclusive" (aka exchange) networks. While plans purchased through Covered California will have the CoveredCA logo on them, the "off exchange" versions of these plans will not. However, regardless of whether they were purchased on or off the exchange, these plans will all utilize the insurer's "Exclusive" exchange networks. When identifying Blue Shield Exclusive Network patients you will need to review both plan and product. Mirror products offered both on and off the exchange may be subject to the lower rate structure. The key in indentifying Exclusive Network products is by verifying the product according to the list in this document. Download the document for a list of all of the various Blue Shield exchange/off-exchange products, a sample eligibility verification and sample member ID cards. Covered California also announced today that it has taken down its provider directories again due to errors in provider participation information. In the meantime, you can still check your participation status via CMA's quick and easy look-up tool at www.cmanet.org/exchange-lookup (available to members only). If you have any questions about your participation status, please contact the plan(s) directly. Contact: CMA's reimbursement helpline, (888) 401-5911 or economicservices@cmanet.org. February 12, 2014 Managed Care Covered California, Health Benefit Exchange, Health Insurance Exchange, Insurance/Reimbursement, Managed Care, Blue Shield 0 0 Comment Read More »
CMA develops simple tool to identify physician participation status in exchange plans On January 1, 2014, Covered California began providing health coverage to more 500,000 patients statewide. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff have a clear understanding of their exchange plan participation status so they can communicate this information to patients before scheduling. It’s equally as important that practices understand the reimbursement rates and other terms associated with the plans with which they are contracted. Even if you did not intentionally contract with any exchange plans, the California Medical Association (CMA) urges physicians to check their participation status. It is very possible that physicians may have been unknowingly opted into an exchange plan network due to the way that major insurance plans have structured their provider agreements. If you've attempted to look up your exchange plan participation status on the Covered California website, you know that it's not a straightforward process. Because it is critical that physicians know what plans they are contracted with, CMA has created a quick and easy tool to look up your exchange plan participation status in just a few clicks. The tool, available to members only, requires simply your first and last name and middle initial and it will tell you which plans list you as a contracting physician (as of September 2013, the most recent data released by Covered California). To access the tool, visit www.cmanet.org/exchange-lookup. Please note: You will be required to login with a member account. If you have not already activated your web account, visit www.cmanet.org/activate. If you need assistance activating your account, contact CMA's member service center at (800) 786-4262 or memberservice@cmanet.org. For more information on Covered California, visit CMA’s exchange resource center at www.cmanet.org/exchange. Physician members and their staff also have free access to CMA’s practice management experts at (888) 401-5911 or economicservices@cmanet.org. January 27, 2014 General Covered California, Health Benefit Exchange, Insurance/Reimbursement, Health Care Reform 0 0 Comment Read More »
Surviving the first month of Covered California On January 1, 2014, California's health benefit exchange, Covered California, began providing health coverage to more 400,000 patients statewide. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff know what to expect. To that end, the California Medical Association (CMA) offers these tips to survive the first month of Covered California. This document is available to members only. Please join CMA or Login to access the document. January 9, 2014 Managed Care Health Insurance Exchange, Covered California, Health Benefit Exchange, Health Care Reform 0 0 Comment Read More »
NEPO launches regional Covered California health care provider outreach and education meetings The CMA Foundation's Network of Ethnic Physician Organizations (NEPO) is hosting its first Covered California provider outreach and education meeting December 7, 2013, at 9:30 a.m. at the Kaplan Medical offices in Pasadena. Physicians and other health care providers and their staff are invited to attend this 2.5 hour educational session. Participants will learn more about Covered California and how they can help patients get health insurance coverage. Registration is free, but space is limited, so secure your spot today. For more information or to register, visit http://www.eventbrite.com/event/9019901769. This is first in a series of regional meetings that will be held throughout the state. Questions? Contact Liza Kirkland, lkirkland@thecmafoundation.org or (916 ) 779-6643. November 6, 2013 General Covered California, Health Benefit Exchange, Network of Ethnic Physician Organizations, Health Care Reform, Health Insurance Exchange, NEPO 0 0 Comment Read More »
Provider search function operational on Covered California website In what has been one of the most fluid deadlines put forth by the state’s health benefit exchange, Covered California launched the online provider search function on Monday, October 7. The search will allow patients to determine if a particular physician is contracted with any of the participating health plans. Though aimed at patients, physicians can also use the search to determine which plans list them on their exchange provider directories. The California Medical Association (CMA) recommends physicians review their status with plans offered in their area to determine whether they are showing as participating or non-participating. The provider search is available through Covered California’s “Preview Plans” tool. To access the search: 1.Visit www.CoveredCA.com and click on the “Start Here” button near the center of the screen. 2.Next, select the “Preview Plans” tab at the top of the next screen. 3.The user will then be directed to provide some general demographic information and click “See My Results” at the bottom right. 4.Click “Preview Plans” again on the next page, then select the “Find Your Doctor or Hospital” bar in the middle of the screen, which opens a dropdown box with both “Find Your Doctor” and “Find Your Hospital” options. 5.Select the “Find Your Doctor” option, and input the physician's name and location. If the desired physician is contracted with a participating Covered California health plan, his or her name should appear in the subsequent provider list. 6.Select the desired name from the list and choose the “Add to My Providers List” option. If you would like to search for another physician, click "Find Your Doctor" again and repeat the process. Once your list is complete, select the “Choose a Plan.” Those plans in which the chosen physician(s) participate will show a green checkmark box in the “My Doctors” row within the summary at the lower half of the page. A red minus-sign box indicates that the physician does participate in the plan. Due to the number of steps and the volume of internet traffic being experienced by Covered California’s website, long load times can be expected. It may be advisable to check the site during low traffic times of the day. Covered California had also promised the ability to download copies of provider directories furnished by qualified health plans via Covered California’s website. This option does not appear to be available yet on the www.CoveredCA.com website as of Monday evening. The topic of provider directories has been one of the most closely watched topics being handled by Covered California, by both patients and the physicians who will ultimately provide care through the state’s new online marketplace. Since early 2013, Covered California has been touting the provider directory as a way to help transform the millions of Californians currently without health insurance into “informed shoppers” when it comes time to enroll. Both provider and patient advocates have been eager to know which providers are being included in the exchange network. Providers’ interest has been stoked by the general ambiguity with which some health plans have conducted their provider contracting, such as failing to identify products as exchange products and using “all products” or “all affiliates” clauses to include physicians in an exchange network. If you find that you are being identified as contracted with an exchange product but did not intend to do so, contact the appropriate provider relations representative at the health plan and CMA’s Center for Economic Services at economicservices@cmanet.org or (800) 786-4262. CMA will continue to monitor the implementation of the Covered California provider directories and keep readers informed of any significant developments. October 8, 2013 General Covered California, Health Benefit Exchange, Health Insurance Exchange, Health Care Reform 0 0 Comment Read More »
CMA optimistic as Covered California opens Sacramento – As Covered California, the state’s Health Benefit Exchange, opened today, California Medical Association (CMA) physicians remain optimistic. Throughout the health care reform debate, CMA strongly advocated for affordable access to care for California’s uninsured and for an expansion of health insurance coverage. “CMA has long supported access to health care for all patients,” said Paul R. Phinney, M.D., CMA president. “Today marks a positive inflection point in our nation's commitment to access to health care for all Americans Five categories of plans will be available through Covered California, consisting of four metal tiers (bronze, silver, gold and platinum) and a catastrophic plan. If offering a metal-tier health plan in Covered California, issuers also must offer the same plan at the same premium outside of the exchange marketplace. “The opening of Covered California is an opportunity for patients who have gone without access to medical care for months, years or even decades to see a physician” added Dr. Phinney. “There is still work to do, since access to insurance does not always guarantee access to a physician. The doctors of CMA look forward to working with Covered California to ensure that all Californians have access to the care they need and deserve." CMA, in conjunction with the CMA Foundation, the Latino Physicians of California and the American Academy of Pediatrics, California, was recently awarded a $1.5 million grant for outreach and education to physicians about Covered California. The focus of the grant is to educate physicians and their office staff about coverage eligibility and patient enrollment. "We are on the ground, communicating with our member physicians and colleagues about Covered California," concluded Dr. Phinney. "We want to make sure physicians and their patients have the information they need to make the goals of Covered California a reality. As with any effort of this magnitude, there will be bumps along the road. We remain committed to the effort nonetheless, and will do our utmost to educate our partners and patients on the significance of this historic change in the delivery of health care." October 1, 2013 General Covered California, Health Benefit Exchange, Health Care Reform 0 0 Comment Read More »
Health Benefit Exchange Toolkit Now Available In 2010, Congress passed historic sweeping health care legislation, the Patient Protection and Affordable Care Act (ACA), which reformed the for-profit health insurance industry and beginning in 2014 will provide health insurance to most of the nation’s uninsured. Under the ACA, two thirds of California’s uninsured will be covered by private insurance through a health insurance exchange purchasing pool. The exchange’s goal is to start pre-enrollment in October 2013. CMA has developed a new toolkit titled, CMA’s Got You Covered: A physician’s guide to Covered California, the state’s health benefit exchange, to educate physicians on the exchange and ensure that they are aware of important issues related to exchange plan contracting. The toolkit is available free to SBCMS/CMA members only at www.cmanet.org/exchange. March 6, 2013 CMA Affordable Care Act (ACA), Covered CA, health benefit exchange 0 0 Comment Read More »
