Clients are learning this applies especially to pediatricians. At this point (late January 2014) most pediatricians in the San Luis Obispo area are not accepting any more Medi-Cal / CenCal patients … even from among their current patient list.
This results in a difficult situation for parents. Their children’s pediatrician with whom they have built a multi-year trusting relationship is no long able to see their children. This begins the very difficult task of searching for a pediatrician who will accept their Medi-Cal insurance … a next to impossible task in this new insurance climate.
There is an option that can help alleviate this situation, and that is the purchase of a private insurance plan for the child. The plans run around $160 / month per child and can be in place alongside Medi-Cal.
We are seeing premium increases between 30-100% of past premium amounts. But even more shocking have been the changes to the network of physicians / hospitals. To contain costs the insurers have created a second tier network that runs alongside their traditional network. Physicians were offered a chance to be in this new network in addition to the traditional one; however this new network would reimburse them at lower rates. As you can imagine, many physicians have not opted to join the new network and have decided to only take plans that use the traditional network (grandfathered and group plans).
This new network is for ALL plans that conform to the Affordable Care Act (new individual and family policies as of 1/1/14). This includes plans purchased from Covered California, direct from the insurance company and plans that replaced old plans as of 1/1/14.
- What Now?
Anthem Blue Cross www.anthem.com/ca Use the Find A Doctor tool on the right side of the page. When performing your search you will be asked to choose a network and a plan. Choose Pathway X PPO for the network and anything for the plan.
Blue Shield www.blueshieldca.com Use the “find a provider” tab on the top of the page. Then you will see a section titled, “select a plan” … hit the select button and choose 2014 Individual and Family PPO (Including Covered California) as the type of plan. Then select your type of plan under Select Sub Plan.
Don’t trust the information regarding whether the physician is taking new patients. Call the physicians office to verify they are accepting new patients and your insurance; do this sooner rather than later. Many people are in your boat. I also recommend checking the dr.’s reviews on www.yelp.com.