California Insurance Commissioner Dave Jones announced today that he as reached a settlement agreement with Blue Shield of California Life & Health regarding the carrier's non-compliance with California's Mental Health Parity law.
Blue Shield of California agreed to end the dispute with the California Dept of Insurance and to cover ABA therapy (Applied Behavioral Analysis) as a life-saving medical benefit for autistic children in California.
Blue Shield of California Life & Health has agreed to cease the following practices:
*Denying ABA therapy as an uncovered service
*Challenging the medical necessity of ABA therapy
*Forcing parents into an unnecessary Independent Medical Review to secure treatment
Blue Shield has agreed to establish a dedicated customer service unit to respond to inquiries from families seeking approval for necessary ABA therapy and to pay for services at higher in-network benefit levels.
Read the CA DOI Press Release
This is very good news for Blue Shield Life & Health subscribers who have autistic children.
Dave
Find Me Here
Tuesday, 31 January 2012
Monday, 30 January 2012
The New Health Law Needs to Be Repealed, Expanded, and Replaced—So Long As It Doesn’t Have a Mandate
Last week’s State of the Union speech was notable because the President hardly mentioned the new health care reform law.Avoiding what is supposed to be the centerpiece domestic accomplishment of President Obama’s first term stuck out like a sore thumb.He said almost nothing because the Obama team simply doesn’t know what to say.The fact is the Affordable Care Act (ACA) is generally unpopular, and
Friday, 27 January 2012
Wellpoint Partnering With Primary Care Physicians
WellPoint (parent company of Anthem Blue Cross), the second largest health insurer in the United States, has established an innovative, patient-centered primary care program that will increase the company's investment in the practices of primary care physicians (PCPs) and in the health of their patients.
WellPoint Press Release (1/27/12)
The program will be initiated in the 3rd quarter of 2012 with anticipation of 100% implementation in all WellPoint states (14) by 2014.
Participating physicians will be able to earn additional revenue in the following ways:
*General increase to the regular fees paid to physician practices for specific services.
*Payment for “non-visit” services currently not reimbursed, with an initial focus on compensation for preparing care plans for patients with multiple and complex conditions.
*Shared saving payments for quality outcomes and reduced medical costs.
Dave
www.davefluker.com
WellPoint Press Release (1/27/12)
The program will be initiated in the 3rd quarter of 2012 with anticipation of 100% implementation in all WellPoint states (14) by 2014.
Participating physicians will be able to earn additional revenue in the following ways:
*General increase to the regular fees paid to physician practices for specific services.
*Payment for “non-visit” services currently not reimbursed, with an initial focus on compensation for preparing care plans for patients with multiple and complex conditions.
*Shared saving payments for quality outcomes and reduced medical costs.
Dave
www.davefluker.com
Wednesday, 25 January 2012
California Child-Only Health Insurance Refresher
Apparently there is a great deal of confusion with regard to child-only individual health insurance policies in California. I thought it would be a good idea to review it here.
Under SB 2244, all children in California under age 19 are eligible to purchase a child-only health insurance plan and they cannot be denied coverage for pre-existing conditions.
It is very important to understand that there is no guaranteed-issue application nor pricing level for children as a direct purchase. Children under 19 applying for individual health coverage must apply for underwritten coverage just like everyone else. If the insurance carrier determines that the child is an acceptable risk then they will issue coverage at the appropriate rating level relative to the risk.
Only if the child is DECLINED for coverage through underwriting do the guaranteed-issue rules come into play. It's not like HIPAA or Major Risk (PCIP or MRMIP) with direct guaranteed-issue pricing and application. Children MUST be underwritten first and declined for coverage before any rules about guaranteed-issue coverage are on the table.
IF the child is declined for coverage through medical underwriting, then the guaranteed-issue rate provisions are utilized to issue coverage on the child.
The rates for declined children who are issued under the child-only guaranteed-issue rules are as follows:
1. Late Enrollee - if a child is considered a late enrollee then the guaranteed-issue rate for that child after a denial from underwriting would be set at approximately double (2X) the standard premium for the plan
2. Not a Late Enrollee - if child is not considered to have late enrollee status and is not in birth month, then the guaranteed-issue rate for the child after denial from underwriting can range from about 350% to 450% above the standard premium for the plan
3. Surcharge - if the child has any gap in coverage between the date of last creditable coverage and the application submission date of the new coverage, the carrier will access a 20% surcharge for one full year above whatever premium rate applies to the child.
I hope this helps to clear up the confusion regarding this issue. Children in California under age 19 are guaranteed-issue in the sense that they cannot be denied coverage. However, the cannot just apply for guaranteed-issue coverage and skip the medical underwriting process. Guaranteed-issue for children in California only applies to children who are denied coverage through medical underwriting.
Dave
www.davefluker.com
Under SB 2244, all children in California under age 19 are eligible to purchase a child-only health insurance plan and they cannot be denied coverage for pre-existing conditions.
It is very important to understand that there is no guaranteed-issue application nor pricing level for children as a direct purchase. Children under 19 applying for individual health coverage must apply for underwritten coverage just like everyone else. If the insurance carrier determines that the child is an acceptable risk then they will issue coverage at the appropriate rating level relative to the risk.
Only if the child is DECLINED for coverage through underwriting do the guaranteed-issue rules come into play. It's not like HIPAA or Major Risk (PCIP or MRMIP) with direct guaranteed-issue pricing and application. Children MUST be underwritten first and declined for coverage before any rules about guaranteed-issue coverage are on the table.
IF the child is declined for coverage through medical underwriting, then the guaranteed-issue rate provisions are utilized to issue coverage on the child.
The rates for declined children who are issued under the child-only guaranteed-issue rules are as follows:
1. Late Enrollee - if a child is considered a late enrollee then the guaranteed-issue rate for that child after a denial from underwriting would be set at approximately double (2X) the standard premium for the plan
2. Not a Late Enrollee - if child is not considered to have late enrollee status and is not in birth month, then the guaranteed-issue rate for the child after denial from underwriting can range from about 350% to 450% above the standard premium for the plan
3. Surcharge - if the child has any gap in coverage between the date of last creditable coverage and the application submission date of the new coverage, the carrier will access a 20% surcharge for one full year above whatever premium rate applies to the child.
I hope this helps to clear up the confusion regarding this issue. Children in California under age 19 are guaranteed-issue in the sense that they cannot be denied coverage. However, the cannot just apply for guaranteed-issue coverage and skip the medical underwriting process. Guaranteed-issue for children in California only applies to children who are denied coverage through medical underwriting.
Dave
www.davefluker.com
Exchange Board seeking nominations for advisory groups
The CT Health Insurance Exchange is soliciting nominations for four advisory committees – health plan benefits and qualifications, small business, consumer experience and outreach, and navigators. The committees are purely advisory to the Board and will “serve to assist the Exchange in establishing policy, refining goals, delineating functions, and providing on-going program evaluation.” The committees will not have voting rights or formal input into policy and will only serve to advise the Board. Committee chairs will be chosen by the Lieutenant Governor. If you are interested in serving, descriptions of the committees, Board members already chairing and populating committees, and a nomination form are online. Nominations are due February 3rd.
Tuesday, 24 January 2012
CT Insurance Exchange seeks comment – sort of
Criticized for spending too much time in secret executive session and insurance industry dominance, the CT Insurance Exchange is finally seeking public comment – sort of. They commissioned a report from Mercer to serve as the foundation for policy decisions in designing the exchange. The report covers a multitude of areas – CT’s insurance market, products currently offered to individuals and small businesses, and demographics and income profile of CT’s uninsured to name a few. The report is 408 pages. The Exchange is soliciting public comment. But you have only a week to read and digest it, do the research to identify gaps and biases, and submit comments which are limited to three pages. There is no commitment or even a discussion of how (or whether) our hard work in commenting will be used or even read.
If this is what passes for public stakeholder input, the Exchange is out of touch.
Update – The comment period has been extended to just under two weeks.
Ellen Andrews
Monday, 23 January 2012
Anthem Medicare Advantage LPPO and Sutter Health Group
Sutter Health Group and Anthem Blue Cross MAPD LPPO (Medicare Preferred PPO and Medicare Preferred Select LPPO) have been unable to reach agreement on a new contract.
As of February 1, 2012, Sutter will no longer be a participating provider for Anthem Blue Cross CA hospital and professional network. The ancillary services for Sutter will continue to be a participating provider.
Again, this contract issue affects Medicare Advantage PPO and Medicare Advantage LPPO subscribers. The following Sutter Health facilities are affected:
Sutter Roseville Medical Center - Roseville, CA
Alta Bates Summit Medical Center - Alta Bates/Herrick - Berkeley, CA
Alta Bates Summit Medical Center - Summit Campus - Oakland, CA
California Pacific Medical Center - California - San Francisco, CA
California Pacific Medical Center - Davies - San Francisco, CA
California Pacific Medical Center - Pacific -San Francisco, CA
California Pacific Medical Center - St. Lukes - San Francisco, CA
Eden Hospital Medical Center - Castro Valley, CA
Memorial Hospital Medical Center - Modesto - Modesto, CA
Memorial Hospital of Los Banos - Los Banos, CA
Menlo Park Surgical Hospital - Menlo Park, CA
Mills Hospital - San Mateo, CA
Novato Community Hospital - Novato, CA
Peninsula Hospital & Medical Center - Burlingame, CA
San Leandro Hospital - San Leandro, CA
Sutter Amador Hospital - Jackson, CA
Sutter Auburn Faith Hospital - Auburn, CA
Sutter Coast Hospital - Crescent City, CA
Sutter Davis Hospital - Davis, CA
Sutter Delta Medical Center - Antioch, CA
Sutter General Hospital - Sacramento, CA
Sutter Lakeside Hospital - Lakeport, CA
Sutter Maternity & Surgery Center - Santa Cruz, CA
Sutter Medical Center of Santa Rosa - Santa Rosa, CA
Sutter Memorial Hospital - Sacramento, CA
Sutter Solano Medical Center - Vallejo, CA
Sutter Tracy Community Hospital - Tracy, CA
I expect that at some point a contract agreement will be reached and will post when that happens.
Dave
Find Me Here
As of February 1, 2012, Sutter will no longer be a participating provider for Anthem Blue Cross CA hospital and professional network. The ancillary services for Sutter will continue to be a participating provider.
Again, this contract issue affects Medicare Advantage PPO and Medicare Advantage LPPO subscribers. The following Sutter Health facilities are affected:
Sutter Roseville Medical Center - Roseville, CA
Alta Bates Summit Medical Center - Alta Bates/Herrick - Berkeley, CA
Alta Bates Summit Medical Center - Summit Campus - Oakland, CA
California Pacific Medical Center - California - San Francisco, CA
California Pacific Medical Center - Davies - San Francisco, CA
California Pacific Medical Center - Pacific -San Francisco, CA
California Pacific Medical Center - St. Lukes - San Francisco, CA
Eden Hospital Medical Center - Castro Valley, CA
Memorial Hospital Medical Center - Modesto - Modesto, CA
Memorial Hospital of Los Banos - Los Banos, CA
Menlo Park Surgical Hospital - Menlo Park, CA
Mills Hospital - San Mateo, CA
Novato Community Hospital - Novato, CA
Peninsula Hospital & Medical Center - Burlingame, CA
San Leandro Hospital - San Leandro, CA
Sutter Amador Hospital - Jackson, CA
Sutter Auburn Faith Hospital - Auburn, CA
Sutter Coast Hospital - Crescent City, CA
Sutter Davis Hospital - Davis, CA
Sutter Delta Medical Center - Antioch, CA
Sutter General Hospital - Sacramento, CA
Sutter Lakeside Hospital - Lakeport, CA
Sutter Maternity & Surgery Center - Santa Cruz, CA
Sutter Medical Center of Santa Rosa - Santa Rosa, CA
Sutter Memorial Hospital - Sacramento, CA
Sutter Solano Medical Center - Vallejo, CA
Sutter Tracy Community Hospital - Tracy, CA
I expect that at some point a contract agreement will be reached and will post when that happens.
Dave
Find Me Here
Advocates protest at last week’s Exchange Board meeting
Last Thursday’s Board meeting was attended by dozens of consumer advocates protesting insurance domination of the Board’s membership and the absence of consumer voices. The advocates wore Band Aids over their mouths and stood with signs protesting the lack of even one voting consumer member; federal regulations say the majority of voting members should represent consumers and small businesses.
Friday, 20 January 2012
Anthem Blue Cross Medicare Supplement Rate Change 2012
Anthem Blue Cross of California has a rate change going into effect on March 1, 2012 for Medicare Supplement plans. This rate change does not affect the individual & family under 65 plans which will be addressed for July, 2012.
Dave
www.davefluker.com
Dave
www.davefluker.com
Blue Shield CA Holding Medicare Supplement Rates
Blue Shield of California has a rate change scheduled for March 1, 2012 for Individual & Family health insurance plans. This rate change does not apply to Medicare Supplements.
Blue Shield of California passed on a Medicare Supplement rate change last August and continued to pass on a rate change again for March 1. 2012.
Current Blue Shield of California Medicare Supplement rates are from 2010 and have not been changed nor adjusted. As of today, Blue Shield of California has no plan to make any rate changes to their Medicare Supplement plans.
I would expect this to be addressed again for August, 2012.
Dave
www.davefluker.com
Blue Shield of California passed on a Medicare Supplement rate change last August and continued to pass on a rate change again for March 1. 2012.
Current Blue Shield of California Medicare Supplement rates are from 2010 and have not been changed nor adjusted. As of today, Blue Shield of California has no plan to make any rate changes to their Medicare Supplement plans.
I would expect this to be addressed again for August, 2012.
Dave
www.davefluker.com
Thursday, 19 January 2012
Important Research From Medicare Demonstration Projects: Almost Nothing Works
I will suggest that most of us believe the way to control health care costs, and at the same time maintain or improve quality, is to both use the managed care tools we have developed over the years, and perhaps more importantly, change the payment incentives so that both cost control and quality are upper most in the minds of providers and payers.The Congressional Budget Office (CBO) has just
Wednesday, 18 January 2012
Will the Feds Be Ready With the Fallback Insurance Exchanges by October 2013?
Insurance exchanges have to be up and running in all of the states by October 2013 in order to be able to cover people by January 1, 2014.If the states don't do it, the feds have to be ready with a fallback exchange. States have to tell HHS if they intend to be ready by January 1, 2013.The White House just released a report saying that good progress is being made in 28 states. That begs the
Tuesday, 17 January 2012
Okay. I am sorry, but I am officially sick to f*cing death of idiots calling in who are completely and utterly unprepared and/or have no idea what the f*ck they're actually calling in the first place.
Let me exemplify.
Me - "Welcome to Health Insurance Inc, how can I help you?
Stupid Customer - "Ummm, yeah, yeah so...ummm...I got like, like, ummm, like a fund thing, you know...ummm...with you like with cover and....I just need to , like....ummm....check stuff"
Me - "Okay. May I please start with your memebrship number sir?"
Stupid Customer - "I dont have it"
Me - "Okay, no problem. If I could please get your name, I can bring the policy up that way"
Stupid Customer - "Ummm, yeah, like, ummmm, my names um, its Rob"
*silence*
Me - "Okay. And your surname please?"
Stupid Customer - "Ummm, like, my last name's, like, like Smith"
Me - "Okay, thanks. How could I help you there today?"
Stupid Customer - "Yeah, so like, with my, like fund, ummmm....ummmm....what am I , like, ummm, you know...."
Me - "I'm sorry sir, no, I dont know what youre referring to?"
Stupid Customer - "Like with my, like...um....my fund, like the cover?"
Me - "You want to know what you're covered for sir?"
Stupid Customer - "Yeah! Yeah like, ummm, like what am I paying for and stuff?"
Me - "Okay, well, you have cover for quite a long list of services, was there a particular service you were wanting me to check for you sir?"
Stupid Customer - "Yeah, like, ummm, yeah, like, check my cover"
Me - "Okay sir, well, we can start with the hospital cover if you like?"
Stupid Customer - "Ummmm, yeah, yeah nar, like, ummm....like Im in like, ummm, a rush, so like, can you just, unmmm....just ummm, like ummm, tell me what I got and sh*t?"
OH how I wish I could hang up on people like this. I really do. They make my brain want to committ suicide.
Let me exemplify.
Me - "Welcome to Health Insurance Inc, how can I help you?
Stupid Customer - "Ummm, yeah, yeah so...ummm...I got like, like, ummm, like a fund thing, you know...ummm...with you like with cover and....I just need to , like....ummm....check stuff"
Me - "Okay. May I please start with your memebrship number sir?"
Stupid Customer - "I dont have it"
Me - "Okay, no problem. If I could please get your name, I can bring the policy up that way"
Stupid Customer - "Ummm, yeah, like, ummmm, my names um, its Rob"
*silence*
Me - "Okay. And your surname please?"
Stupid Customer - "Ummm, like, my last name's, like, like Smith"
Me - "Okay, thanks. How could I help you there today?"
Stupid Customer - "Yeah, so like, with my, like fund, ummmm....ummmm....what am I , like, ummm, you know...."
Me - "I'm sorry sir, no, I dont know what youre referring to?"
Stupid Customer - "Like with my, like...um....my fund, like the cover?"
Me - "You want to know what you're covered for sir?"
Stupid Customer - "Yeah! Yeah like, ummm, like what am I paying for and stuff?"
Me - "Okay, well, you have cover for quite a long list of services, was there a particular service you were wanting me to check for you sir?"
Stupid Customer - "Yeah, like, ummm, yeah, like, check my cover"
Me - "Okay sir, well, we can start with the hospital cover if you like?"
Stupid Customer - "Ummmm, yeah, yeah nar, like, ummm....like Im in like, ummm, a rush, so like, can you just, unmmm....just ummm, like ummm, tell me what I got and sh*t?"
OH how I wish I could hang up on people like this. I really do. They make my brain want to committ suicide.
Sunday, 15 January 2012
Me - "Welcome to Health Insurance Inc, how can I help you?"
Stupid Customer, in a REALLY stuck up voice - "What do you want first? The reference number of the claim you stuffed up?"
Me - "Just the membership number to the account please ma'am, and I can proceed from there"
*I get all her details, bring up the claim in question, read through it, and prepare to watch a rude woman get OWNED*
Stupid Customer - "Right so you got my claim there? Huh? Do you? Got it on your screen, yeah?"
Me - "Yes ma'am, I have here your pharmacy claim. I can see it is for *name of item*, whcih pays a set rebate of $20 regardless of the cost of the item or your level of cover. I can see that you received that set $20, so how could I help you today with that one?"
Stuipd Customer - "Um...WHAT? I only get $20 back? Surely that is a GRAVE ERROR!"
Me - "No ma'am, as advised this item pays a set rebate of $20. If you refer to your policy guide or our website and look up this item, you will see it states there quite clearly that the set rebate is $20. So I can definetely get the claim looked into if you like, but I just need you to please advise what the actual error with the claim is?"
*insert sweet smile*
Stupid Customer - "Well this is just a JOKE. Pathetic! Such a measly amount, which do I even bother"
Me - "As mentioend ma'am, these kinds of benefits are well publicised and it is your choice to claim or not"
Stupid Customer - "Whatever. You guys are a rip off" ... *CLICK*
Okay. So. I do FULLY get that not everyone will be happy with the rebates they get. And that is fine, you are more than welcome to call in and gripe about that [to an extent]
BUT
DONT call in RUDE and on your freakin high horse from the get go when you havent bothered to ever read what it is that you are ACTUALLY entitled to
That will just make you look stupid. Oh so stupid.
That is all
:D
Stupid Customer, in a REALLY stuck up voice - "What do you want first? The reference number of the claim you stuffed up?"
Me - "Just the membership number to the account please ma'am, and I can proceed from there"
*I get all her details, bring up the claim in question, read through it, and prepare to watch a rude woman get OWNED*
Stupid Customer - "Right so you got my claim there? Huh? Do you? Got it on your screen, yeah?"
Me - "Yes ma'am, I have here your pharmacy claim. I can see it is for *name of item*, whcih pays a set rebate of $20 regardless of the cost of the item or your level of cover. I can see that you received that set $20, so how could I help you today with that one?"
Stuipd Customer - "Um...WHAT? I only get $20 back? Surely that is a GRAVE ERROR!"
Me - "No ma'am, as advised this item pays a set rebate of $20. If you refer to your policy guide or our website and look up this item, you will see it states there quite clearly that the set rebate is $20. So I can definetely get the claim looked into if you like, but I just need you to please advise what the actual error with the claim is?"
*insert sweet smile*
Stupid Customer - "Well this is just a JOKE. Pathetic! Such a measly amount, which do I even bother"
Me - "As mentioend ma'am, these kinds of benefits are well publicised and it is your choice to claim or not"
Stupid Customer - "Whatever. You guys are a rip off" ... *CLICK*
Okay. So. I do FULLY get that not everyone will be happy with the rebates they get. And that is fine, you are more than welcome to call in and gripe about that [to an extent]
BUT
DONT call in RUDE and on your freakin high horse from the get go when you havent bothered to ever read what it is that you are ACTUALLY entitled to
That will just make you look stupid. Oh so stupid.
That is all
:D
Me - "Welcome to Health Insurance Inc, how can I help you?"
Stupid Customer - "What?"
Me - "You've come through to Health Insurance Inc, how can I help you today sir?"
Stupid Customer - "What?! Speak up!"
Me, raising my voice - "Hello sir, youve come through to Health Insurance Inc, how can I help you today?"
Stupid Customer - "Oh god, I can't hear you! For f*ck sake! [to someone in background] This girls a f*cking idiot!"
Me, voice now deadpan - "I can hear you fine sir. How can I help?"
Stupid Customer - "WHAT!!! I cant hear a word you're saying! [again to person in background] F*ck this girl is an idiot, I swear, a massive f*cking idiot, she's all ooohhhh how can I HELP you today SIIIIR, hahahahaha"
Me - "Im sorry sir, it seems you're having some trouble on your end there because I can actually hear you perfectly well, you might want to call back from different line?"
Stupid Customer - "What! You're just going to hang up on me! What kind of bullsh*t service is that?!"
Me - "I'm sorry sir, you advised me that you couldn't hear me at all?"
Stupid Customer - "Of course I could hear you you f*cking idiot1 Jeez, lighten up! I'm just messing around with you! it's not like it matters anyway, you're just a call centre monkey! And I'm the customer and I can treat you however I like! [To person in background] God can you believe this girl? Who does she think she is? Hahahahaha"
Me - *hangs up*
What a douche.
Stupid Customer - "What?"
Me - "You've come through to Health Insurance Inc, how can I help you today sir?"
Stupid Customer - "What?! Speak up!"
Me, raising my voice - "Hello sir, youve come through to Health Insurance Inc, how can I help you today?"
Stupid Customer - "Oh god, I can't hear you! For f*ck sake! [to someone in background] This girls a f*cking idiot!"
Me, voice now deadpan - "I can hear you fine sir. How can I help?"
Stupid Customer - "WHAT!!! I cant hear a word you're saying! [again to person in background] F*ck this girl is an idiot, I swear, a massive f*cking idiot, she's all ooohhhh how can I HELP you today SIIIIR, hahahahaha"
Me - "Im sorry sir, it seems you're having some trouble on your end there because I can actually hear you perfectly well, you might want to call back from different line?"
Stupid Customer - "What! You're just going to hang up on me! What kind of bullsh*t service is that?!"
Me - "I'm sorry sir, you advised me that you couldn't hear me at all?"
Stupid Customer - "Of course I could hear you you f*cking idiot1 Jeez, lighten up! I'm just messing around with you! it's not like it matters anyway, you're just a call centre monkey! And I'm the customer and I can treat you however I like! [To person in background] God can you believe this girl? Who does she think she is? Hahahahaha"
Me - *hangs up*
What a douche.
Friday, 13 January 2012
California Mandatory Maternity Benefits SB 222
Effective July 1, 2012, all individual & family health insurance plans in California must provide maternity coverage to subscribers.
The Bill, SB 222, was passed into law in late 2011 and requires all individual & family health insurance plans in California to include coverage for maternity including prenatal and postnatal. This includes plans registered with both the CA Dept of Managed Health Care (DMHC) and the CA Dept of Insurance (CDI). The law, signed by Gov Brown in 2011, estimates an average cost increase (premium) of about $7 per month per subscriber.
As of this date none of the California health insurance carriers selling individual & family coverage have announced how they intend to implement the new benefits. I expect most if not all carriers will simply add the benefit to existing plans without creating a new series of "open" plans to accommodate the new benefit.
This benefit additiona affects all individual & family health plans. Anyone currently on a non-maternity coverage plan in California will have the benefit added on July 1, 2012.
CA SB 222
Dave
Find me here
The Bill, SB 222, was passed into law in late 2011 and requires all individual & family health insurance plans in California to include coverage for maternity including prenatal and postnatal. This includes plans registered with both the CA Dept of Managed Health Care (DMHC) and the CA Dept of Insurance (CDI). The law, signed by Gov Brown in 2011, estimates an average cost increase (premium) of about $7 per month per subscriber.
As of this date none of the California health insurance carriers selling individual & family coverage have announced how they intend to implement the new benefits. I expect most if not all carriers will simply add the benefit to existing plans without creating a new series of "open" plans to accommodate the new benefit.
This benefit additiona affects all individual & family health plans. Anyone currently on a non-maternity coverage plan in California will have the benefit added on July 1, 2012.
CA SB 222
Dave
Find me here
Thursday, 12 January 2012
I Hope Trustmark Tells HHS to Go Pound Sand
Today, the Department of Health and Human Services announced that, "Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states."The HHS statement continued, "In these five states, Trustmark has raised
Tuesday, 10 January 2012
2012: A Year of Huge Uncertainty in Health Care Policy
2013 may be the most significant year in health care policy ever.But we have to get through 2012 first.Once the 2012 election results are in there will be the very real opportunity to address a long list of health care issues.If Republicans win, the top of the list will include “repealing and replacing” the Affordable Care Act. If Obama is reelected, but Republicans capture both houses of
OP-ED: Health Insurance Exchange Needs a Passionate and Visionary CEO
As Connecticut prepares to launch its Health Insurance Exchange (HIX) as part of health care reform, those of us that live and work here must work together to ensure our needs as consumers are met. It is concerning that the Board of the HIX is composed of several recent insurance company executives and almost no consumers. The Board is currently in the midst of hiring the CEO and the other key management positions. If as citizens and consumers, we fail to make our voices heard and advocate for a CEO that is consumer-oriented; the Board will most likely either hire a mid-level insurance company executive or a bureaucrat as the CEO. As consumers, we would then not have a reform oriented CEO that would be a passionate visionary in helping create an effective HIX that will make real health insurance plan choices available in Connecticut for Individuals and Small Businesses.
Since the HIX is a quasi-government start-up small business enterprise, basically a health insurance brokerage firm, it is extremely important that the person have experience in growing a small business from 5-to-50 employees in under a year; and that they are very familiar with the inner-workings of the State Capitol. If the CEO is not a passionate visionary that understands the significant positive impact the HIX will can have for Connecticut’s citizens, it is highly unlikely that the person will be willing to work the typical 60 plus hours a week that a small business owner works when growing a business; or, find ways to overcome governmental hurdles that will be an inherent part of launching the HIX. The CEO should be knowledgeable and experienced with Connecticut’s current health insurance marketplace for Individuals and Small Businesses; including the differences in mandates. For example, maternity, normal childbirth, is not a covered or mandated benefit in Individual health insurance plans; but small business health plans do mandate coverage for the benefit. A CEO that is consumer-oriented would most likely advocate for covering maternity in Individual health plans; instead of leaving Medicaid to cover all pregnancies in the Individual marketplace.
If the citizens of Connecticut do not advocate for a passionate consumer-oriented reform minded visionary as the CEO of the HIX, it is likely that we will be left behind, again. As an example of the need to advocate today; at a recent HIX Board meeting, a consultant with experience in launching the Massachusetts Health Exchange several years ago stated that Connecticut should look to their experience and avoid the mistakes they made in launching their exchange and significantly underestimating how many people would turn to the exchange for their health benefits. One of our HIX Board members stated that the consultant’s numbers of possible enrollees in Connecticut’s HIX were too optimistic at ~100,000; and that even 40,000 enrollees would be an overly optimistic number for January 1, 2014. The comment was that there is no significant cost savings to consumers; and that the Federal Premium Subsidies for Individuals and Federal Tax Credits for Small Businesses only available through the HIX would not be significant enough for consumers or Small Business owners to make the effort to purchase their health insurance plans through the exchange.
Tony Pinto
Friday, 6 January 2012
MA Connector speaker Monday talks about small businesses and the exchange
Patrick Hollander, former CFO of the MA Health Connector will speak at the Speaker’s Working Group on Small Business Health Care Monday Jan. 9th at 3pm in Room 1D of the LOB.
The next meeting of the CT Health Insurance Exchange Board is set for Jan. 19th at 9am in Room 1A of the LOB.
Thursday, 5 January 2012
Express Scripts and Walgreens
Effective January 1, 2012, Walgreens is no longer contracted with Express Scripts.
For those with health insurance plans using Express Scripts as the pharmacy contract provider (Anthem Blue Cross, TRICARE), you will be required to change your provider pharmacy if you are using Walgreens pharmacy.
Dave
For those with health insurance plans using Express Scripts as the pharmacy contract provider (Anthem Blue Cross, TRICARE), you will be required to change your provider pharmacy if you are using Walgreens pharmacy.
Dave
Me - "Welcome to Health Insurance Inc, how can I help you?"
Stupid Customer - "Your automatic payment line told me to come here"
*silence*
Me - "Oh...okay. Did it...um...I'm sorry. Just to clarify ma'am, because our payment line is fully automated - when you say it told you to 'come here', what exactly do you mean by that?"
Stupid Customer - *sigh* "I tried to pay my bill, so I'm TRYING to give you people money, and it said there was an error and I had to call this number to get it resolved. I better be getting a months free premium on my policy for this, it's a massive inconvenience that your systems are broken like this! I'm just trying to do the right thing and pay my bill here!"
Me - "Okay ma'am. So when you say it said there was an error, what was the exact error message being given so I can have a look into this for you?"
Stupid Customer - "It didn't say anything, it just said there was an error and I had to call you. I had better be compensated for this"
Ah-huh. At this stage I am calling bullshit every which way. Why? out automated system is set in a way where you key in details and that's it. There is no 'voice' going on about 'errors' and all this crapola. If the system is down, you can't dial through at all. Simple.
Me - "Hmmmm. That sounds very unusual ma'am. I mean, as far as I'm aware our payment system doesn't have the function of a voice-over..."
*interrupting me*
Stupid Customer - "LOOK it said there was a f*cking error so you gonna fix it or what? Or are ya' stupid or somethin', huh?"
Me, now deadpan - "What was your membership number?"
Stupid Customer - "I dunno, I gotta go grab it, how come you need it?"
Me - "The 'error' that you're talking about is not one that I have ever heard of before ma'am, I was not aware it existed, therefore to try and pinpoint the problem I'm going to have to log into your account and view the activity log, that may indicate to me where things are going wrong"
Stupid Customer - "Fine, whatever"
*She gives me her membership details. I log in...read the activity log...and with a HUGE smile go back to the line and say in the MOST polite, sweet-as-pie voice I can muster...*
Me - "Thanks for holding there ma'am. So I can see here that you actually dialled the payment line several times in the past few minutes, and each time made it through to the payment section when you enter your credit card details. It shows here that each time you did that, your card was declined, at which point you disconnected the call on your end. There are no errors recorded - all that's happened here ma'am is you called our payment line several times and then hung up each time your card was declined. As such I'm sorry but there is no error with our systems, you are not entitled to any form of compensation. You are welcome to make payment on your policy once your credit card issue has been resovled on your end"
Stupid Customer, muttering - "Bitch"... *CLICK*
Ah-huh.
Now that's what I call OWNED.
Stupid Customer - "Your automatic payment line told me to come here"
*silence*
Me - "Oh...okay. Did it...um...I'm sorry. Just to clarify ma'am, because our payment line is fully automated - when you say it told you to 'come here', what exactly do you mean by that?"
Stupid Customer - *sigh* "I tried to pay my bill, so I'm TRYING to give you people money, and it said there was an error and I had to call this number to get it resolved. I better be getting a months free premium on my policy for this, it's a massive inconvenience that your systems are broken like this! I'm just trying to do the right thing and pay my bill here!"
Me - "Okay ma'am. So when you say it said there was an error, what was the exact error message being given so I can have a look into this for you?"
Stupid Customer - "It didn't say anything, it just said there was an error and I had to call you. I had better be compensated for this"
Ah-huh. At this stage I am calling bullshit every which way. Why? out automated system is set in a way where you key in details and that's it. There is no 'voice' going on about 'errors' and all this crapola. If the system is down, you can't dial through at all. Simple.
Me - "Hmmmm. That sounds very unusual ma'am. I mean, as far as I'm aware our payment system doesn't have the function of a voice-over..."
*interrupting me*
Stupid Customer - "LOOK it said there was a f*cking error so you gonna fix it or what? Or are ya' stupid or somethin', huh?"
Me, now deadpan - "What was your membership number?"
Stupid Customer - "I dunno, I gotta go grab it, how come you need it?"
Me - "The 'error' that you're talking about is not one that I have ever heard of before ma'am, I was not aware it existed, therefore to try and pinpoint the problem I'm going to have to log into your account and view the activity log, that may indicate to me where things are going wrong"
Stupid Customer - "Fine, whatever"
*She gives me her membership details. I log in...read the activity log...and with a HUGE smile go back to the line and say in the MOST polite, sweet-as-pie voice I can muster...*
Me - "Thanks for holding there ma'am. So I can see here that you actually dialled the payment line several times in the past few minutes, and each time made it through to the payment section when you enter your credit card details. It shows here that each time you did that, your card was declined, at which point you disconnected the call on your end. There are no errors recorded - all that's happened here ma'am is you called our payment line several times and then hung up each time your card was declined. As such I'm sorry but there is no error with our systems, you are not entitled to any form of compensation. You are welcome to make payment on your policy once your credit card issue has been resovled on your end"
Stupid Customer, muttering - "Bitch"... *CLICK*
Ah-huh.
Now that's what I call OWNED.
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