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FWIW as of 2015 California requires there be "primary care network providers with sufficient capacity to accept covered persons within 30 minutes or 15 miles of

FWIW as of 2015 California requires there be "primary care network providers with sufficient capacity to accept covered persons within 30 minutes or 15 miles of each covered person's residence or workplace", specialists within 60 minutes or 30 miles, and that there be sufficient capacity for doctors within those limits to accept new patients[1]. Getting that enforced isn't easy, but that situation not only shouldn't happen but should also be grounds for regulatory action against the insurer. [1] http://www.insurance.ca.gov/0400-news/0100-press-releases/2015/upload/nr012-NetworkAdequacyApproval.pdf http://www.insurance.ca.gov/0400-news/0100-press-releases/20...

DrScump 11y ago
Getting that enforced isn't easy How is that even possible? How does the state mandate that some random provider step in and subsidize higher payments to providers in order to encourage them to take on more new patients?
- YokoZar 11y ago
  By preventing them from selling their insurance on the state-run exchange if they don't meet the standards.
  - DrScump 11y ago
    OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients. There is a good article on this problem (many doctors not accepting new patients, leaving regions without care except for ERs) on the front page of the 5/18/15 San Jose Mercury News.
    - magicalist 11y ago
      > OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients It has nothing to do with coercing doctors. Why would it? If a insurance network can't meet its obligations it will be fined or shut down. If an insurer has to pay more money to a doctor in some area to meet its obligations it will then have to (though undoubtedly that will be eventually passed on to its customers). Meanwhile it's an agonizingly slow process to get justice for the people that need it, but insurance companies forced to refund money for not meeting their network coverage requirements is in the news right now, specifically because "more than 25% of physicians listed by Anthem and Blue Shield weren't taking patients in the Covered California health exchange or were no longer at the location listed by the companies, according to the state's investigation." http://www.latimes.com/business/healthcare/la-fi-obamacare-network-probe-20151103-story.html http://www.latimes.com/business/healthcare/la-fi-obamacare-n...
      - DrScump 11y ago
        That article talks about fines for overstating their networks -- stating in marketing materials that they had more participating doctor availability in given region(s) than they actually had availability for all policies offered. False advertising, in a sense. That is very different from the problem statement: how do you make a network offer inducements at a loss to recruit additional providers? I'd guess that most people buying off CoveredCA.org don't even bother to look at participating providers accepting new patients before buying a policy. There is no element of law that says to an underwriter, "Hey, you gotta add more providers in this area and that area now, or we will punish you." The law doesn't give government that power.
        magicalist 11y ago
        > That article talks about fines for overstating their networks -- stating in marketing materials that they had more participating doctor availability in given region(s) than they actually had availability for all policies offered. False advertising, in a sense. They weren't falsely bragging about numbers in marketing materials, they were listing specific doctors at specific addresses in their tools for finding in-network doctors that were not in their network or were not at that address. Different from geographic density but related. > That is very different from the problem statement: how do you make a network offer inducements at a loss to recruit additional providers? It's really not complicated: by saying they can't operate in a certain area without a sufficient network. They either recruit more doctors or they pack up. Perhaps you're missing that insurance companies in California don't usually operate statewide? I assume this is common across the country. The key is that care has to be available near your house or workplace. When applying for insurance you are specifically offered companies that have coverage in those areas (often at the county or city level of granularity). You can't sign up for an insurance policy at the other end of the state from a company's network of doctors and expect them to sign up doctors around you, because, again, if they don't have sufficient density of doctors where you are, they don't cover people there in the first place. > There is no element of law that says to an underwriter, "Hey, you gotta add more providers in this area and that area now, or we will punish you." The law doesn't give government that power. Yes, it really really does.
      - 11y ago
- magicalist 11y ago
  Are you really asking how the state can regulate an insurance company? If a company can't meet network requirements it can't operate.
DrScump 11y ago
If you read the document in your link, you will see that that regulation expired last July.
- magicalist 11y ago
  That was just the emergency amendment. It's codified: https://govt.westlaw.com/calregs/Document/IE282722688B248DFA4FBD9E4C42A0A8A#co_anchor_IF24218ACCE4646438329A1F9C9344EFD https://govt.westlaw.com/calregs/Document/IE282722688B248DFA...
  - DrScump 11y ago
    That's just another emergency amendment that expires in less than 3 weeks. Scroll to the bottom of your link.

DrScump 11y ago

Getting that enforced isn't easy How is that even possible? How does the state mandate that some random provider step in and subsidize higher payments to providers in order to encourage them to take on more new patients?

YokoZar 11y ago
By preventing them from selling their insurance on the state-run exchange if they don't meet the standards.
- DrScump 11y ago
  OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients. There is a good article on this problem (many doctors not accepting new patients, leaving regions without care except for ERs) on the front page of the 5/18/15 San Jose Mercury News.
  - magicalist 11y ago
    > OK, name one case where that has actually happened -- where the state has successfully coerced a doctor to accept new patients at a loss or a provider to overpay to make such a doctor/group choose to accept new patients It has nothing to do with coercing doctors. Why would it? If a insurance network can't meet its obligations it will be fined or shut down. If an insurer has to pay more money to a doctor in some area to meet its obligations it will then have to (though undoubtedly that will be eventually passed on to its customers). Meanwhile it's an agonizingly slow process to get justice for the people that need it, but insurance companies forced to refund money for not meeting their network coverage requirements is in the news right now, specifically because "more than 25% of physicians listed by Anthem and Blue Shield weren't taking patients in the Covered California health exchange or were no longer at the location listed by the companies, according to the state's investigation." http://www.latimes.com/business/healthcare/la-fi-obamacare-network-probe-20151103-story.html http://www.latimes.com/business/healthcare/la-fi-obamacare-n...
    - DrScump 11y ago
      That article talks about fines for overstating their networks -- stating in marketing materials that they had more participating doctor availability in given region(s) than they actually had availability for all policies offered. False advertising, in a sense. That is very different from the problem statement: how do you make a network offer inducements at a loss to recruit additional providers? I'd guess that most people buying off CoveredCA.org don't even bother to look at participating providers accepting new patients before buying a policy. There is no element of law that says to an underwriter, "Hey, you gotta add more providers in this area and that area now, or we will punish you." The law doesn't give government that power.
      - magicalist 11y ago
        > That article talks about fines for overstating their networks -- stating in marketing materials that they had more participating doctor availability in given region(s) than they actually had availability for all policies offered. False advertising, in a sense. They weren't falsely bragging about numbers in marketing materials, they were listing specific doctors at specific addresses in their tools for finding in-network doctors that were not in their network or were not at that address. Different from geographic density but related. > That is very different from the problem statement: how do you make a network offer inducements at a loss to recruit additional providers? It's really not complicated: by saying they can't operate in a certain area without a sufficient network. They either recruit more doctors or they pack up. Perhaps you're missing that insurance companies in California don't usually operate statewide? I assume this is common across the country. The key is that care has to be available near your house or workplace. When applying for insurance you are specifically offered companies that have coverage in those areas (often at the county or city level of granularity). You can't sign up for an insurance policy at the other end of the state from a company's network of doctors and expect them to sign up doctors around you, because, again, if they don't have sufficient density of doctors where you are, they don't cover people there in the first place. > There is no element of law that says to an underwriter, "Hey, you gotta add more providers in this area and that area now, or we will punish you." The law doesn't give government that power. Yes, it really really does.
    - 11y ago
magicalist 11y ago
Are you really asking how the state can regulate an insurance company? If a company can't meet network requirements it can't operate.

DrScump 11y ago

If you read the document in your link, you will see that that regulation expired last July.

magicalist 11y ago
That was just the emergency amendment. It's codified: https://govt.westlaw.com/calregs/Document/IE282722688B248DFA4FBD9E4C42A0A8A#co_anchor_IF24218ACCE4646438329A1F9C9344EFD https://govt.westlaw.com/calregs/Document/IE282722688B248DFA...
- DrScump 11y ago
  That's just another emergency amendment that expires in less than 3 weeks. Scroll to the bottom of your link.