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California officials scrutinizing narrow networks


California insurers are raising rates by an average of 4.2 percent, but state insurance officials aren't challenging the increased premiums. However, they are scrutinizing insurers' narrow networks, reported the Los Angeles Times.

"After careful and in-depth analysis, the [California Department of Managed Health Care] found that the health plans' proposed premium rates are actuarially sound," DMHC Director Shelley Rouillard told the Times.

But the department is still reviewing insurers' networks to determine whether they have included enough doctors, hospitals and other providers for plans sold on the health insurance exchange. Health Net, for example, is replacing some of its plans sold on the health insurance exchange with more restrictive policies that have 54 percent fewer providers.

The department is also investigating whether Anthem Blue Cross and Blue Shield of California misled consumers about their networks and thus made it too difficult for them to get treated. Consumer Watchdog sued Blue Shield, claiming the insurer offered inadequate provider networks and incorrectly advertised which providers were in network.

Meanwhile, DMHC is reviewing seven insurers, including Aetna, Anthem Blue Cross, Blue Shield of California, Health Net, Kaiser and United Healthcare, for excluding coverage for voluntary and elective abortions, the Bakersfield Californian reported.

After receiving a letter from DMHC warning them that their exclusions violate state law, the seven insurers are deciding how to respond. "If there's any corrective action needed, we'll certainly take that action, but at the moment we're working through that issue," Blue Shield spokesman Sean Barry told the Bakersfield Californian

To learn more:
- read the Los Angeles Times article
- see the Bakersfield Californian article

Related Articles:
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States won't likely boost oversight of narrow networks
Narrow networks lower spending by a third, research finds
Abortion coverage info not clear in exchange plans
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