Hoag’s doctors could be mostly off limits under new health law

As healthcare providers throughout the country scramble to keep up with Affordable Care Act’s ongoing rollout, officials at Hoag Hospital in Newport Beach said its doctors will be accessible through the state’s insurance exchange.

But while Chief Financial Officer Jennifer Mitzner said the situation “continues to be rather fluid,” Hoag is so far participating in one insurance plan available through Covered California.

“As we move through 2014, we will partner with [Covered California] health plans to see if we can get them offered,” she said Friday. For now, though, “Hoag feels we are represented on the exchange.”

Mitzner added that it’s insurance companies — not hospitals or physician groups — that decide whether to offer plans on the exchange.

Area residents planning to enroll in health insurance through Covered California can see Hoag doctors only if they choose a Health Net PPO available through the exchange. Otherwise, doctors in the Hoag Medical Group will be considered out of network.

Mitzner said she couldn’t yet say how well that particular plan, which is specifically tailored to the exchange, has been selling. Health Net, however, is one of the hospital’s top insurers, and its existing plans account for thousands of Hoag patients.

Statewide, Health Net accounted for 15.7% of the people who signed up for plans through Covered California in October, according to a report by the agency’s director.

Terry Schmidt, a lecturer in UC Irvine’s public health department, said it makes sense that Hoag might take a cautious approach to the new law.

“If I was a CFO of a hospital, I’d probably want to dip my toe in,” he said, “but if I was a consumer, I’d want them to participate in all of [the health plans.]”

Mitzner said that the community Hoag serves is largely insured by Medicare or employer-provided insurance. Hoag also participates in individual insurance plans not offered on the state exchange.

As a result, “I think, by and large, Hoag is not going to be affected very much,” said Glenn Melnick, director of USC’s Center for Health Policy and Management. “Even if they’re participating in every single plan, my guess is the number of new people in their service area is not going to be very large.”

Still, he cautioned, some parts of California may soon find themselves facing a “tremendous doctor shortage,” which could trickle over into areas that are currently well-served.

In October, 2,379 Orange County residents enrolled in insurance through the state exchange, the report said, and 9,011have completed applications.

That’s why Hoag Medical Group was formed about a year ago, Mitzner said — to address what is expected to be a growing demand for primary care doctors.

A potential shortage of primary care doctors, she said, was “on Hoag’s radar since even before ACA.”

Hoag Medical Group is comprised of 40 doctors in eight locations around the county, according to hospital officials.

Mitzner said Hoag will continue to invest in and grow the group as necessary to “ensure reasonable access to primary care in the community.”

Anyone with more specific questions about their healthcare should call the Hoag Personal Service Team at (800) 400-4624.