SACRAMENTO – First District Assemblyman Wesley Chesbro (D-North Coast) has introduced a bill, AB 2586, that would help protect and maintain access to health care by ensuring patients have full and complete information about their health care provider network.
“This bill will help the state crack down on health plans and insurers that promise consumers a fully staffed physician network, but instead give them a phantom network with insufficient providers and misleading provider directories,” Chesbro said.
“Some of these provider directories even include names of physicians who are deceased, retired or no longer practicing in the state,” he said.
The most recent and egregious example is Anthem Blue Cross’ attempt to force new and unfair contracts on Healthy Families providers in Humboldt County, according to Chesbro.
This “recontracting initiative” gave physicians no choice but to sever their relationships with Blue Cross, which left children enrolled in Healthy Families with no access to medically necessary care other than the emergency room
“AB 2586 will also require health plans and insurers to get approval from regulators before narrowing or modifying its provider network through re-contracting schemes,” he said. “And they will be required to notify affected enrollees and providers before terminating contracts and narrowing networks.”
If it becomes law, AB 2586 will require:
HMOs and health insurers to make sure that provider directories are accurate and up-to-date.
That the state Department of Managed Healthcare and the Department of Insurance review the adequacy of physician networks, accessibility by geography and physician-to-patient ratios every time it conducts an on-site survey. Currently, these criteria are only reviewed once, when the plan is initially licensed.
“Lack of access to care in many regions of California is a serious problem because some health plans don’t provide big enough networks of physicians for their patients,” said Dr. Luther Cobb, a surgeon at Mad River Community Hospital in Arcata and on staff at St. Joseph Hospital in Eureka. “AB 2586 will put a stop to this and give regulators more effective ways to regularly monitor the availability of health coverage in local markets.”
Dr. Cobb is a member of the California Medical Association’s (CMA) Executive Committee. The CMA is sponsoring AB 2586.