I remember Regal before their affiliation with the Heritage Providers and it was no problem in the earlier days but their affiliation now is changing things for patients.  Since the patient purchased his policy through Covered California, it was ok, then one day, he can’t see his doctor anymore as they don’t see any Covered California patients.  That is frustrating and this might go back to the mess with doctors getting paid 30% less from Blue Cross and Blue Shield with policies bought through the exchange.  It was so bad for a while that the insurers had to go back and up the reimbursement a bit and still the lists of who was in network and who was not was still a mess. 

In some cases the insurers were sending the doctor reimbursements to the patients who wanted to keep the money. 

Blue Shield Billing Fiasco With Policies Bought Via Covered California - Checks Are Going To the Patients and Not the Doctors Who Some How Ended Up No Longer As Covered Providers…More Killer Algorithms Creating More Obstacles to Getting Care…

Here’s what one doctor has to say:

“Blue Shield announced to all that for their Covered California Health Plan all its Blue Shield providers are on the plan. I had patients sign up specifically because they saw I was on the plan (the same happened to other physicians as well). However once the plan went into effect most of the physicians contracted with Blue Shield were no longer listed as contracted providers.

Furthermore after we provided services to  these patients the Explanation of Medical Benefits fromimage Blue Shield showed that we were discounted some 20-30% of our previously paid services and the check was now going to the patient and not the provider.   We have been trying to get these checks from the patients who love getting these Blue Shield checks and keeping them. As physicians are finding this out they are mad and are starting to demand payment up front from the patient and give them a superbill so they can bill Blue Shield. What a mess.”

So maybe Regal decided not to mess with it at all?  What really made the patient mad is the fact that Heritage gets grants from the Feds for being an Accountable Care Organization and is so well touted as being a model, and yet there’s no model here and no care for him and he especially was not happy about the mention of Medicare patients getting free dance lessons and healthy cooking classes as well as casino excursions when he couldn’t see his doctor. 

So here we go, everything working fine and then all stops due to a bunch of crappy algorithms that won’t work together.  This is what the big problem is with Obamacare, everyone’s math that doesn’t jive.  BD 

Obamacare - One Big “Attack of the Killer Algorithms” No Matter Which Direction You Turn, Compounded With a Lot of Government and Consumer “Algo Duping”….

We've had the same doctor for 20 years. On August 1st his individual practice merged into Regal Medical Group, a large, multi-area medical group. Regal Medical Group is an Independent Practice (or Physician) Association, or a group of individual doctors who combine their practices into one large group.

No problem, we thought. Sure, they're located farther away, but it's not terrible. Worth the extra time driving to keep a doctor who knows us and knows our history. But we just discovered how wrong we were.

I've written in the past about our son's ongoing health issues. Last year, he signed up for Covered California and bought the Platinum plan through Blue Shield. It's expensive for a 25-year old, but he wisely decided it was worth paying extra for the peace of mind he would get from knowing he'd have deductible-free coverage for his health issues. His doctor was in the network, so all was good.

Until the merger. This week, he had a flareup on the diabetes management side of things and so he called the doctor and made a sort-of-emergency appointment. He showed up for the appointment this morning, presented his insurance card and was told they don't take any insurance under Covered California.

I couldn't quite believe the text I saw from him. Blue Shield policies are exactly the same from a coverage and deductible standpoint, whether purchased on the exchange or not. Regal Medical Group accepts Blue Shield coverage for employers and other sponsors, including Medicare.

They just don't take coverage under the ACA.

Regal Medical Group, by the way, is a for-profit concern. Their arrogance in this situation is enough to make me want to spread the word far and wide that greed is no substitute for compassion, particularly when their patients can pay.



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