For the thousands of people who signed up for insurance through the Covered California exchange, getting access to care will depend on which health plans they chose.
Many physicians in the Modesto area have a wait and see attitude about accepting patients enrolled in the four Covered California health plans in Stanislaus County, said Dr. Amarjit Dhaliwal, past president of the Stanislaus Medical Society.
Dhaliwal, who has supported federal health reform, said he expects his group will accept some referrals in January for patients needing treatment and will see if the reimbursements are adequate.
We have been told the rates will be the same as Medicare rates for certain specialty procedures, said Dhaliwal, an oncologist with Valley Cancer Medical Group. If they dont pay near the Medicare rates, that certainly will be a problem. You can have an insurance card that says you are covered, but if you are not finding a physician, what good is that?
News reports that some Covered California health plans will reimburse doctors at 70 percent of Medicare rates have dampened enthusiasm among health care providers. Some local doctors said they had not talked with the insurers and did not know whether the payment rates will cover the costs of care.
With major provisions of health reform going live in the new year, people who enrolled in Covered California health plans before the Dec. 23 deadline will start seeking access to care this week. In Stanislaus County, the choices are Anthem Blue Cross, Blue Shield, Kaiser Permanente and HealthNet.
People who enrolled with Kaiser are expected to use its clinics and medical centers or physicians that contract with the Oakland-based health system. Kaiser wont be an option for consumers who went with the three other plans.
On Monday, a spokeswoman for Doctors Medical Center said she confirmed the Modesto hospital is part of the provider networks for the Blue Shield, Anthem Blue Cross and HealthNet plans offered through Covered California. The hospitals parent company is poised to complete an acquisition of Turlocks Emanuel Medical Center within a month, so the hospital is expected to accept the same three health plans.
Health care providers associated with Sacramento-based Sutter Health are keeping their distance from the Covered California offerings. Memorial Medical Center and the Sutter Gould Medical Foundation are in the provider network of only the Blue Shield plans. Sutter Gould has more than 240 physicians serving patients in Stanislaus, San Joaquin and Merced counties.
Patients who are treated at a hospital or clinic that is outside their health plans provider network are charged for higher copays and a larger percentage of the medical bill.
Information was not available from Stanislaus Surgical Hospital, Oak Valley Hospital in Oakdale or the AllCare Independent Physician Association, which says its independent doctors care for 45,000 patients in Stanislaus and Merced counties.
Dr. Ronald Goldman, president of Valley Oak Pediatric Associates in Modesto, said the group hopes to welcome more patients by participating in the Covered California plans, except for Kaiser.
He said Valley Oak lost 2,000 patients with the elimination of the states Healthy Families program last March 31. The program served children in working-poor families.
We are not 100 percent sure of the reimbursements from (Covered California health plans), but we are pretty sure it will be at least the same as Medicare for office visits, Goldman said. There are a lot of kids out there and probably not enough providers. We want to fill in the gap.
The pediatrician added that problems with the Covered California enrollment process and lack of awareness make him wonder how many children will be newly insured.
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or (209) 578-2321.