Dr. Mark Dressner says California’s public exchange need to act now to keep physicians in the networks.
Dressner, president of the California Academy of Family Physicians, said doctors who treat Covered California exchange plan patients feel confused, frustrated and poorly paid.
“We have never received such an outpouring of complaints about plans’ contracting strategies,” Dressner writes in a letter included in a Covered California board meeting packet.
And the problem?
Doctors say plan reimbursement rates are 20 percent to 40 percent lower than traditional plan rates.
“Our physicians describe these payment reductions as unaffordable to their practices,” Dressner says.
In some cases, Dressner says, carriers seem to think they can change contract terms by simply sending letters to the physicians.
Physicians have trouble finding out what the plan contract terms are, or even finding out whether they’re really in a plan provider network, Dressner says.
Dressner says his group is telling physicians they have to negotiate terms with the plan issuers just as they would with any other private payers.
And the answer is quite simple. Opt out of the system.