Covered California

Tom DiCioccio of Oceanside owes nearly $20,000 for his cancer surgery this year after Blue Shield switched him into a policy with fewer providers. The insurer agreed to pay his bills after The Times asked about the case.

Chad Terhune
June 28, 2014

Frustration and legal challenges over the network of doctors and hospitals for Obamacare patients have marred an otherwise successful rollout of the federal healthcare law in California.

Limiting the number of medical providers was part of an effort by insurers to hold down premiums. But confusion over the new plans has led to unforeseen medical bills for some patients and prompted a state investigation.

More complaints are surfacing as patients start to use their new coverage bought through Covered California, the state’s health insurance exchange.

“I thought I had done everything right, and it’s been awful,” said Jean Buchanan, 56. The Fullerton resident found herself stuck with an $8,000 bill for cancer treatment after receiving conflicting information on whether it was covered.

“How am I going to come up with that much money?”

Insurers insist that pruning the network of doctors is a crucial cost-cutting measure and a major reason that so many Californians could find affordable coverage in the health law’s first year.

“These narrow networks are making a huge difference in terms of affordability,” said Mark Morgan, president of Anthem Blue Cross, a unit of industry giant WellPoint Inc. “We found in convincing numbers that people value price above all else.”

But regulators, lawmakers and consumer advocates are pushing back to ensure patients know what they’re giving up in return for lower rates — and don’t run into unnecessary roadblocks to care.

This month, the California Department of Managed Health Care began investigating whether two major insurers, Anthem Blue Cross and Blue Shield of California, are violating state law related to inaccurate provider lists and offering timely access to treatment.

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