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Marin's Uninsured Population Shrinking Thanks To Obamacare

MARIN INDEPENDENT JOURNAL
https://insurancenewsnet.com/oarticle/2015/11/15/marins-uninsured-population-shrinking-thanks-to-obamacare.html

Nov. 15--Marin health officials say the number of uninsured residents in the county is dwindling as the Affordable Care Act's third open-enrollment season begins this month.

But consumer advocates say medical insurance customers face an uphill battle when trying to figure out which plan is the best buy for them. They say insurance costs, especially in Northern California, are increasing while the network of doctors offered in plans is narrowing.

Since the initial enrollment period in 2013, 16,774 Marin residents have purchased insurance through Covered California, the state's health insurance exchange, and another 14,563 Marin residents have gained access to medical care via Medi-Cal, said Sparkie Spaeth, deputy director of the county's Department of Health and Human Services.

"Those are pretty high numbers for this county," Spaeth said. "It begs the question of how deep can your saturation go."

Spaeth said there is no data on precisely how many Marin residents remain without medical insurance. In August 2013, the Sacramento Bee reported that Marin was the California county with the lowest rate of uninsured residents: 12 percent. Given that Marin's population in 2013 was 258,365 that 12 percent would amount to about 31,000 people, roughly the same number that has gained coverage since implementation of the Affordable Care Act.

Spaeth said the 12 percent figure "was the number we were working off of in 2013, and we've exceed that."

She added, however, "I think it would be a stretch for me to say that virtually everybody in Marin is now insured because it's a moving target."

Use caution

Carmen Balber, executive director of Consumer Watchdog, a nonprofit based in Santa Monica, said people purchasing health insurance for the first time or switching plans during this enrollment period need to proceed with caution.

Earlier this month, the California Department of Managed Health Care fined Anthem Blue Cross $250,000 and Blue Shield $350,000 for inaccurate provider directories. After receiving numerous complaints between January and May 2014, the department surveyed the plans' provider networks. It found that for Blue Shield, about 18 percent of the physicians listed in Blue Shield's provider directory were not at the location listed and, of those who were at the location listed, 8.8 percent were not willing to accept members enrolled in Blue Shield's Covered California products. For Anthem, 12.5 percent of the physicians were not at the location listed in the provider directory and, that of those who were at the location listed, 12.8 percent were not willing to accept patients enrolled in Anthem's Covered California products.

The Department of Managed Health Care said both insurers must reimburse policyholders who were negatively affected. It said Blue Shield had already reimbursed more than $38 million to enrollees who incurred out-of-network costs.

Lindy Wagner, a spokeswoman for Blue Shield, said, "The settlement addresses past issues raised in 2014, and our members should not be concerned about their current plan or its networks."

Confusion

In the spring of 2014, Marin residents scheduling medical procedures at local hospitals reported that they were having trouble determining if medical groups supplying ancillary services to the hospitals -- anesthesiologists, radiologists, pathologists and hospitalists -- had contracted with Blue Shield and Anthem Blue Cross to serve their new Affordable Care Act customers. Calls to medical groups and insurance companies elicited sometimes contradictory responses regarding whether the groups were contracting with the insurance companies.

Representatives of Anthem and Blue Shield say that Marin Medical Laboratories, California Advanced Imaging Medical Associates, Medical Anesthesia Consultants, Anesthesiology Consultants of Marin, Marin Hospitalists Medical Group and Marin Emergency Physicians Medical Group are currently part of their networks. But it is impossible to verify that using the insurance companies' online search tools. Both companies said that customers need to contact their customer service departments if they want to confirm that a medical group providing ancillary services belongs to their networks.

Consumer Watchdog's Balber said, "We always recommend that consumers contact both their health plan, their health insurance company and their physician to double-confirm that the doctors they want to see are in the network they're choosing."

Narrow networks

Balber said that while consumers can research whether a specific doctor is part of the plan they're thinking of purchasing, "one of the biggest problems that is now emerging is how narrow networks are to begin with."

A University of Pennsylvania study released in August ranked California as one of the top four states with the most narrow networks. The study rated 75 percent of California health insurance networks as "narrow."

"You can confirm your existing doctors are in the network, but you have no way of knowing what kind of specialists you might need six months from now," Balber said.

But Darrel Ng, a spokesman for Anthem, said, "Studies show that narrow networks cut costs, but not quality. The head of Covered California is on the record supporting narrow networks. "

And as networks grow narrower the price of health insurance is rising.

"Northern California is seeing the largest rate increases by far, as high as an average of 12.8 percent in some counties," Balber said. "So consumers need to shop around."