The Anthem Blue Cross and Blue Shield health insurers must take additional steps to fix their inaccurate provider directories or face possible financial or legal penalties, California's Department of Managed Health Care said Tuesday.
The Department's random phone survey of providers listed in the companies directories revealed that 18 percent of the doctors listed in Blue Shield's directory were not at the listed location, and 8.8 percent of them would not accept patients enrolled in its plans offered through Covered California.
In Anthem Blue Cross' case, the Department survey found that 12.5 percent of physicians in the company's provider directory were not at the listed location, and 12.8 percent would not take patients enrolled in its Covered California plans.
The inaccurate directories resulted in "a highly unacceptable consumer experience," the report said.
The Department said it investigated the accuracy of the two insurance giants' directories this past summer after receiving "numerous complaints...from consumers who were having difficulty finding in-network physicians."
The report noted that each company has already begun "corrective action, which includes efforts to monitor and improve the accuracy of its Provider Directories, to verify the status of contracting providers and to directly contact providers to confirm their contracted status."
Still, the Department said that each company has failed to fully address three areas in which it is violating California's Health and Safety Code, all related to the inaccuracy of their provider directories.
Because of those violations, the Department has referred the matter to its Office of Enforcement, which could choose to take "corrective action," according to the report. That could include anything from financial penalties to cease and desist orders, according to Department spokesman Rodger Butler.
"The vast majority of the issues raised in the Department's report have either been corrected by Blue Shield or were never caused by Blue Shield in the first place," the insurer's Vice President of Corporate Communications Stephen Shivinsky wrote to KPCC in an e-mail.
He criticized the Department's "flawed methodology," saying the report "is misleading and has the potential to further confuse members by significantly overstating the severity of the issues."
Anthem spokesman Darrel Ng acknowledged in a statement that "some providers were inadvertently listed in error," while noting that "the vast majority of providers in our directory were correct." He stressed the various steps Anthem is taking to improve the accuracy of its listings.
The problem of faulty provider networks has been an ongoing issue since last year's launch of Covered California. In Anthem's case, it led to the filing of a class action lawsuit against the company in July.
The results of the Department's investigation are "deeply troubling," said Anthony Wright, Executive Director of the consumer advocacy organization Health Access California. He called on the Department "to impose fines and more importantly corrective action plans on insurers that can't keep their most basic commitment to consumers to have accurate and adequate networks and access to care."