How Physicians Should Prepare for 2015 Covered California Changes

November 15 marked the open enrollment period for the Covered California exchange. There have been some changes to the medical plans and policies covered under the exchange which will be announced as they are released. Covered California representatives are encouraging all physicians and policy holders to become familiarized with some of these updates especially since they predict that there will be a 45% increase in enrollment compared to 2014.

How should participating physicians prepare:

  • Verify that they are still part of a carrier’s network (many providers have narrowed their networks since 2014 so it’s important to check on this status)
  • Verify the exchange product type (make sure that your practices are still covered under the new plans and product offerings of the providers on the Covered California exchange for 2015)
  • Ensure that staff members are knowledgeable of benefit packages, product offerings, and coverage options for plans on the Covered California exchange. For example, if a patient says that they are covered by Health Net, the staff member should ask what plan or policy that individual has because it may not be covered in the provider network

80% of respondents to a Covered California survey mentioned that they were unsure of their participation status in Covered California. With so many changes to provider network, policies, and information, physicians feel that this confusion is negatively impacting their healthcare offerings. The California Medical Association is trying to help physicians transition through this unfamiliar process by providing a guide to help them better understand patient participation status.

How are you planning to deal with the changes in your practice in 2015?


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