Can’t find a doctor? California bill would punish insurers for giving customers outdated info
by Ryan Sabalow
July 29, 2024; Updated July 30, 2024
In summary
Patients looking for doctors who will take their insurance often find the list of doctors provided by their insurance companies are inaccurate or out of date. Insurers and doctors are fighting a bill that would fine insurers for having “ghost networks” that aren’t accurate.
Over the years, licensed therapist Sarah Soroken has heard from her patients again and again about what a miserable experience it can be to find a mental health provider who actually takes their insurance. But one patient stands out.
Soroken said she was working at Kaiser’s Vallejo Medical Center in 2022 when a college-aged woman was admitted to the hospital’s emergency room after she attempted suicide.
The patient, Soroken said, gave up and tried to take her own life after she called a list of 50 mental-health providers who were listed as taking Kaiser’s insurance plan, but none would see her, or they didn’t actually take her insurance.
“This patient now has the traumas of a suicide attempt and having been harmed by our health care system to add to their treatment needs,” Soroken told the Senate Health Committee earlier this month.
Soroken, who no longer works for Kaiser, testified in support of Assemblymember Chris Holden’s Assembly Bill 236. The legislation from the Pasadena Democrat would give state regulators authority to fine insurers if their lists of in-network doctors, hospitals, mental health workers, labs and imaging centers aren’t up-to-date and accurate.
The bill tackling what are disparagingly called “ghost networks” has so far passed the Assembly and the Senate Health Committees with only Republicans in opposition, and despite the lobbying powerhouses representing California doctors and insurers fighting the bill every step of the way. Doctors and insurers blame each other for problems in the directories, but they argue the bill is unnecessary, burdensome on them and that laws on the books already address the problem.
Combined, the groups have given at least $4.7 million to California legislators since 2015, according to the Digital Democracy database.
State health agency cites huge costs
Along with opposition from influential lobbyists for doctors and insurers, the measure also received a lukewarm response from the state agency that would enforce the bill if it becomes law.
As the Legislature and Gov. Gavin Newsom sought to address a $30 billion budget deficit this year, the Department of Managed Health Care estimated that the bill would cost $12 million to bring on “additional staff.” According to the bill’s analysis, the new employees are needed to develop regulations, forms and to monitor “provider directory accuracy.”
The estimate of $12 million is the equivalent of 80 employees each making $150,000 a year – figures that could alarm Newsom’s budget team and the lawmakers who dole out cash to state agencies on the Senate Appropriations Committee, where the bill will be considered in the coming weeks.
The department didn’t respond to CalMatters’ request to explain its estimate. In a one-paragraph emailed statement, Kevin Durawa, a department spokesperson, said the estimate may be out of date since the bill was recently amended.
“The department is reviewing the amendments to the bill and how they may impact the fiscal estimate,” Durawa said.
Ken Cooley, a former Democratic Assembly member from Sacramento County who sat on the Assembly Insurance Committee, said he wouldn’t be surprised that the department analyzed the bill “with a vengeance” to possibly overestimate the costs.
“If they don’t like it, if they think it’s the wrong priority, whatever it is, they would be remiss if they didn’t try to lay out every argument,” he said.
But Cooley said solving the problem of inaccurate provider lists is worth fighting for.
“I’m not familiar with the specific bill, but…
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