Directories of doctors given to low-income patients across California are highly inaccurate, making it difficult for them to get the health care they’re entitled to under state law, the California Health Report has found.
More than half of the primary-care doctors in provider directories given to low-income patients in three counties in Northern, Central and Southern California are not accepting new patients with Medi-Cal, the state’s low-income health plan, or could not be reached by telephone.
At one plan in Butte County, more than 95 percent of the doctors listed in the printed directory were either unavailable to new patients or could not be reached. Even in the most accurate directory, from a plan in Fresno County, reporters were able to confirm that a doctor would see a new patient at only six out of every ten offices listed.
Some of the doctors listed in the directories have moved out of the area, retired or are otherwise no longer practicing. Others who are erroneously listed have decided to stop accepting Medi-Cal, while some said they never accepted the insurance. Some of the phone numbers listed have been disconnected, are for the wrong office or are actually fax numbers. Many of the receptionists who answered the phone said they had never heard of the doctor who was listed as practicing at their office.
The accuracy of the physician directories is important for two reasons. First, consumers searching for a doctor need to be able to find one, a task already difficult because so few doctors accept Medi-Cal patients. If the directories are filled with the names of physicians who don’t accept Medi-Cal, finding a doctor is even more challenging, and could even force patients to delay or go without care.
Second, the state requires insurance companies that offer plans through Medi-Cal to demonstrate that their physician networks are adequate for their patient load. The insurers submit separate quarterly reports to the state with information on which doctors are accepting patients. The state uses those reports to determine if there are enough doctors to treat those enrolled in the plans.
The inaccuracy of the directories calls into question whether many of the doctors also listed in the quarterly reports are actually accepting patients. If those reports are inflated by the names of doctors who are not available, the plans may be violating state law and regulations.
“This is a very real issue that is affecting millions of people in California,” said Anthony Wright, executive director of Health Access California, a nonprofit advocacy group. “No directory is going to be 100 percent perfect, but if you’re at 50 or 60 percent accurate, that’s just not acceptable. Finding a doctor who is accepting patients — it should not be a flip of a coin or worse. This is a real problem.”
The number of people enrolled in Medi-Cal has grown substantially in the last six months under the federal Affordable Care Act. About 10.6 million people — more than a quarter of the state’s population — are enrolled in Medi-Cal.
The state Department of Health Care Services is responsible for making sure that insurers offering Medi-Cal plans have adequate doctor networks and comply with regulations, which include updating their directories every six months. Another state office, the Department of Managed Health Care, licenses all health plans in the state and is also in charge of making sure that consumers have adequate access to doctors and the ability to choose their primary-care provider.
“It is the plan’s responsibility to get the updated list and to have those on hand, so we certainly want the plans to be able to provide that for their members,” said Norman Williams, spokesman for the Health Care Services department. “It is a requirement within the law.”
Marta Green, spokeswoman for the Managed Health Care department, encouraged Medi-Cal enrollees who are having trouble finding a doctor to contact the agency’s health center.
Green said her department is investigating the adequacy of doctor networks offered on the Covered California exchange by Anthem Blue Cross and Blue Shield of California after receiving a number of complaints.
“Provider networks and adequacy is a key focus for the DMHC and the department is closely monitoring all complaints regarding networks and access issues for all market segments — both commercial and government-sponsored,” Green said in an email message. “The DMHC will continue to take action against plans that fail to ensure their enrollees get timely access to appropriate health-care services.”
Nicole Kasabian Evans, spokeswoman for the California Association of Health Plans, which represents Medi-Cal managed-care plans in the state, said the plans update their provider lists “on a very regular basis.” But sometimes, she said, inaccuracies occur when doctors fail to notify the plans that they are no longer accepting patients.
“Plans have to really rely on physicians to keep them updated,” she said. “Doctors are supposed to notify the health plan, but unfortunately it doesn’t always happen.”
But some doctors say the health plans are at fault.
The California Medical Association, which has launched its own investigation of doctor directories in Northern California, said that doctors have reported that their practices are often listed erroneously even after they tell insurers that they are no longer accepting patients.
What reporters found
Overall, 48.1 percent of doctors listed in the PDF directories and website indexes for Butte, Fresno and Imperial counties were not accepting new patients or could not be reached. The PDFs were less accurate than the data accessed via website search functions. The PDFs listed an average of 53.1 percent of doctors who were not accepting new patients or could not be reached, while the percentage was 37.1 for the website data.
Research on website indexes in 10 other counties across the state showed similar rates of inaccuracy. Of the 175 doctors called in those counties, 78 said they were not accepting new patients or could not be reached, or 44.6 percent.
In Butte County, a small, rural county in Northern California, reporters called doctors listed in directories from Anthem Blue Cross and California Health and Wellness, the two managed-care plans there. About 95.3 percent of doctors listed in the Anthem PDF directory and 56.5 percent listed on the website were not accepting new patients or could not be reached. For California Health, the percentages were 61.6 for the PDF and 71.4 for the website.
In Fresno County, located in the center of the state, reporters conducted research on the Medi-Cal directories issued by Anthem and CalViva Health in that county. About 49.8 percent of doctors listed in the Anthem PDF directory and 43.7 percent listed on the website were not accepting new patients or could not be reached. For CalViva, the percentages were 40.7 for the PDF and 36.9 for the web.
In Imperial County, which borders Mexico, reporters called doctors listed in directories from California Health and Wellness and Molina Healthcare of California. About 65.6 percent of doctors listed in the California Health PDF and 22 percent listed on the website were not accepting new patients or could not be reached. A PDF directory was not available on the Molina website, but the search function on the website yielded the only completely accurate provider list of the three counties. It was also the smallest list, with only six doctors.
When people enroll in a Medi-Cal managed care plan, they are usually assigned a primary-care physician or they have the option of selecting a doctor. They’re given a directory to page through, in case they want to choose their own physician. In some cases, such as if people are also eligible for another government insurance program or if the insurers make a mistake, people may not be assigned a primary-care provider.
In addition, there is a period of about 30 days, before they enroll in a plan, but after the state has processed their paperwork, where clients are on their own to find a physician if needed.
Greg Hund, CalViva’s CEO, said he wasn’t surprised to learn that about four in 10 doctors listed in his company’s directory for Fresno County weren’t accepting patients or couldn’t be reached.
“That history has been going on for a long time here in the (San Joaquin) Valley,” he said. “The majority of the providers are in it to take care of their existing patients.”
Hund and several of the other insurers contacted said having an accurate directory was a difficult task.
“It’s always been a challenge for any health plan to have a provider list that’s accurate,” he said. “As soon as you get published, somebody retires or somebody decides not to accept. That’s not just to do with the Medi-Cal program — any health plan has the same challenge.”
Kasabian Evans, with the Association of Health Plans, and several of the insurers the Health Report contacted questioned whether it mattered if the directories are inaccurate, because enrollees are almost always assigned a primary-care physician when they sign up.
“When members want to switch their primary care doctors, all they need to do is call Anthem and we will find them a new doctor accepting additional patients,” Darrel Ng, Anthem spokesman, said in an email message. Anthem operates Medi-Cal plans in 28 counties.
But the Health Care Services department said that patients must have the option to choose their doctor, and having an accurate directory is an important part of that.
“We want them to have options, we want them to have choices and to be able to receive the care they need, with someone they feel comfortable with,” Williams said.
Poor struggle to get access
Sommak Chounlamany, 45, a Fresno resident, is just one example of how the faulty directories affect consumers. He was excited to benefit from the expansion of Medi-Cal this year under the Affordable Care Act. Having emigrated from Laos nearly two decades ago, he had never had health insurance before.
But when he enrolled in Anthem’s Fresno County Medi-Cal plan last month, he was told to choose a primary-care provider and had trouble finding one, he said, speaking through an interpreter.
“If I hadn’t had help, I don’t think I could have found a doctor,” he said.
Chounlamany turned to Sophia DeWitt, interim co-director of Fresno Interdenominational Refugee Ministries, a nonprofit group that helps refugees and new immigrants. But even DeWitt, who is health insurance savvy, said she had a hard time finding him a doctor.
“There were five offices where they spoke Laotian, and I called five places, and four of them said no, they weren’t accepting patients, so I was at the point where there was only one option left,” she said. “There wasn’t much choice for him.”
DeWitt said her office is hearing similar complaints from Medi-Cal enrollees every week.
“Its one thing to sign people up for insurance, but then people come back once they’re signed up because they get information from Fresno County or their health plan that includes their card and it says, ‘Please chose a doctor,’” she said. “People don’t know what to do with that.”
Theresa Rivera, a program manager for Rowell Family Empowerment, a nonprofit that helps children with special needs, also considers herself good at navigating government programs, but she has had trouble finding a doctor for her four oldest kids. The children, who range in age from 10 to 16, enrolled in Medi-Cal late last year in Butte County, she said. Before they were assigned a primary-care physician, Rivera said she went through a number of hoops to try to find one.
The situation soon became urgent because one of her daughters contracted strep throat. Unable to reach a doctor that was accepting patients, she ended up taking her to an emergency clinic.
Rivera said she then called a number of doctors listed in California Health’s directory, scrambling to find a primary-care provider with enough openings to take all four of her children in time for them to get physicals to play school sports. She said she made three trips to the county Medi-Cal enrollment office and close to a dozen phone calls during her lunch breaks at work trying to find a doctor for her kids.
“We never did actually find one, and after all the back and forth and all the time, we just kind of gave up,” she said. “Our kids are pretty healthy, but I can’t imagine if they were in serious need.”
Rivera, who moved with her family to Shasta County this month, said she’s still looking for a primary-care physician for her children there.
Claudia Boyd-Barrett and Angela Woodall contributed to this report.
Medi-Cal enrollees who are having trouble accessing care can contact the state Department of Managed Health Care Help Center at 888-466-2219.