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Health Insurer Says Individual Plans Will Have Fewer Doctors Next Year

Nov 11, 2013

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Credit Andrew Nixon / Capital Public Radio

California health insurers say people buying coverage for themselves next year should expect a different set of doctors and hospitals than are available this year. Health Care Reporter Pauline Bartolone has more.

Anthem Blue Cross and Blue Shield of California are the largest issuers of individual health insurance policies in the state. Jeff Smith of Blue Shield said in order to keep its plans affordable next year, it negotiated with doctors and hospitals.

“What we did was look for what price point we felt was going to be affordable in the market, and really worked with each provider to sign a contract at these rates. And the rates were lower than what we paid them previously," says Smith.

He says lower payments for doctors and hospitals will be offset by a larger customer base.  But not all providers wanted the new arrangement. Seventy five percent of Blue Shield’s current hospitals and 50 percent of its doctors will be in next year’s network. But Smith says tens of thousands of doctors will still be available.

"We still have a very broad network,” says Smith.

Darrel Ng of Anthem Blue Cross said its mix of participating hospitals and doctors next year will be ‘different.’

"We sought to find providers who met quality benchmarks, but would be willing to work with us to provide an affordable product," says Ng.

But Ng said it’s hard to say how next year’s roster of providers and their pay might compare to this year.