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California doctors, insurers face off over reimbursement rates – San Jose Mercury News

February 24th, 2014

California doctors, insurers face off over reimbursement rates – San Jose Mercury News.

An informative article from San Jose Mercury News providing some background on why individuals in Covered California plans have experienced difficulties finding providers willing to accept them.

The takeaway: Scaling up via the health benefit exchanges benefits the insurance market but not necessarily the provider side where payers have pushed higher patient volume to drive down reimbursement rates. The economics of supply and demand are pushing back with limited numbers of providers to service the increased demand, putting the providers in the drivers seat.

An insurance company spokesperson quoted in the story warns that economic reality could result in higher insurance rates — just as Covered California prepares to negotiate plan year 2015 rates with participating health plans.

 


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email fpilot@pilothealthstrategies.com or call 530-295-1473. 

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