Anthem Blue Cross and Blue Shield of California, two of California's largest health insurers, misled customers about the number of doctors in their networks under plans sold through the state's insurance marketplace, according to a state report released Tuesday.
The California Department of Managed Health Care began investigating in May after patients complained they were told that certain medical providers were included when they chose a health plan, only to find out after their appointment that their doctor was not part of their network. Seeing an out-of-network doctor increases costs significantly for patients.
About 200 complaints were filed against the companies earlier this year based on plans sold through Covered California, the entity created to carry out the provisions of the federal Affordable Care Act.
The department cited the insurers for various deficiencies in how they publicized their physician networks. It found the insurers' online provider directories listed physicians that were outside their networks and that they failed to correct inaccuracies. They issued statements "that were either untrue or misleading and which were disseminated, at least in part, for the purpose of inducting persons to enroll in the plan."
Anthem and Blue Shield say the state's survey is flawed and noted that doctors were not obligated to participate in the survey. The insurers said there is often confusion within doctors' offices about which health plans they accept.
The state "relied on an unsound methodology to obtain its raw data, and then made misleading and inappropriate conclusions based on inaccurate data," Anthem wrote in its response to the state's findings.
Both insurers have acknowledged they made mistakes but say they have tried to fix them and have added thousands of new providers. Anthem spokesman Darrel Ng said the health plan followed up with the doctors who said they didn't accept the plan and found that 99 percent had contracts with the insurer.
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"We're not saying that everything is perfect," he said. "We've taken great steps to try to remedy that situation."
Together, Anthem Blue Cross and Blue Shield of California accounted for nearly 58 percent of those who signed up for private health insurance through the exchange.
The state said that while it understands the insurers' concerns, "they do not change the fact that the significant inaccuracies contained in the plan's online provider directory resulted in a highly unacceptable customer experience, nor do they change the fact that California consumers could not reach or did not have access to providers who were represented as being part of the plan's network."
