Doctors Discriminating Against Covered California Plans

Posted: July 25, 2016

by John Hansen

Physicians Who Discriminate Against Covered California Will Face Disciplinary Actions by the State Exchange

Many Covered California consumers have complained during the first couple years of the Affordable Care Act that they are having trouble getting their doctors to accept their health insurance coverage. Physicians and clinics have made the following statements.

“We don’t take Covered California plans”

This could be for various reasons. In some cases, medical insurance carriers payout less for the California Health Exchange plans, so physicians don’t want to accept them. In other cases, it’s just that doctors have heard they might get paid less.

“We only take platinum or gold plans”

Some doctors don’t want to take the more affordable Bronze and Silver Covered California plans. These plans require the customer to pay out more money at the point of service. Some physicians are concerned about having to hunt down payments from customers on these lower end plans.

“We get paid less for Covered California plans”

In most cases, this is not true. However, sometimes there are differing payout schedules for individual health insurance plans than for group health insurance plans. Covered California mostly sells individual plans. So if the issue is between accepting a Covered California individual plan and a small business plan, there may be a difference with regard to provider reimbursement schedules.

Covered California Cracking Down on This “Discrimination”

Covered California has declared these statements and these practices as “discriminatory”. This discrimination against Covered California plans has not been taken lightly by the California Health Exchange. Consumers who hear any of the above comments from a doctor, hospital or clinic may report this to Covered California, who commits to take action on the behalf of consumers.