Connecticut's health insurance exchange had a smoother first week than many of its counterparts across the country trying to enroll potential customers in health plans.
But Connecticut shoppers trying to find which doctors and hospitals are covered by the health plans sold on the state’s exchange are getting uneven results.
Access Health CT, the state’s exchange, is relying on the insurance companies to provide links to directories of health care providers who accept their exchange plans. Shoppers who enter their age, county and income on Access Health's website can view a list of available plans and prices. Under each option there's also a link to "Check if your doctor is in-network."
But those links don't all lead to provider directories.
For Anthem Blue Cross and Blue Shield's plans, the links go to Anthem's main website. There's no obvious way to find the provider directory for exchange plans.
There is a way to do so, but it requires some website navigation and some knowledge of how Anthem labels its exchange plans.
The first step is to click on the words "FIND A DOCTOR" on the right side of the homepage. That brings up a search page for health care providers. In the field that asks for "Plan type/Network," people looking for information on exchange plans should select one of the options labeled "Pathway X."
"It's a work in progress, and it's something that we're looking to enhance," Anthem spokeswoman Sarah Yeager said.
The process is easier for the other carriers selling plans through the state's individual exchange.
The link for plans offered by HealthyCT, a new insurer, goes to a search page for participating health care providers, all of whom accept the carrier's exchange plans. And the link for ConnectiCare’s plans takes users to a search page for a directory of health care providers that accept plans offered on the exchange.
Relying on the carriers to supply the links to information on providers was a deliberate choice by Access Health, CEO Kevin Counihan said, to allow the exchange’s staff to focus on other things as they developed the insurance marketplace.
“We wanted to outsource as much operational processes as possible,” Counihan said, noting that Access Health also outsourced the billing to the individual insurers and contracted with the company Maximus to run its call center. “Our view early on was to focus, was to try to identify those things that added the most value to the customer, the first one being a stable IT system, and then let other parties do those things that they did better so we didn’t replicate existing functions.”
What role will the exchange play in making sure that customers can get the information they need from the insurers’ websites?
“We’re still in the development stage of making sure that the information that they have up there is user-friendly for our consumers,” Access Health spokeswoman Kathleen Tallarita said Wednesday. “There’s still a lot of work that’s being done behind the scenes on it.”
The exchange monitors the adequacy of the insurers’ provider networks, which are required to be substantially equal to those used for each carrier’s commercial plans. But exchange staff didn’t have access to the provider networks until Oct. 1, the day the marketplace opened for enrollment. They said the carriers were treating the provider networks as proprietary information, making them unable to review the lists before plans were offered for sale.
But Tallarita noted that since none of the plans take effect until Jan. 1, there’s time for people to consider their options and make changes.
The exchange’s open enrollment period runs through March 31, but people who want coverage to take effect Jan. 1 must apply by Dec. 15.