Archive for the ‘Laws’ Category
Tuesday, January 24th, 2012
Anthem Blue Cross policyholders who remained on grandfathered plans (those administered by the Department of Managed Health Care rather than the Department of Insurance) faced an unexpected surprise. Along with increased premiums, their plan benefits changed as well. Co pays, deductibles, and out of pocket maximum amounts all increased as a result of these changes. Anthem said this was a necessary move to keep up with increasing health costs, but policyholders had enough, and Consumer Watchdog stepped in. The lawsuit that has been filed states that Anthem used “bait and switch” tactics, leaving “consumers are left with no certainty about what they will have to pay and what coverage they’ll receive.” Many customers who had met their deductible earlier in the year were surprised to receive bills from their providers stating that they had not yet reached their portion of medical expenses, though the patient was under the impression they had.
The lawsuit serves to protect the 100,000 policyholders who have experienced what they feel is a misrepresentation of plan coverage. Company spokespeople from Anthem state that there is no violation of state laws and regulators were made fully aware of the proposed plan changes. Consumer Watchdog stated that even though these state regulators were aware of the plan changes, they in no way received a stamp of approval to move ahead with them. Per Jerry Flanagan, staff attorney at Consumer Watchdog, “Basically, higher deductibles mean you’re paying more for less health care. It’s a change to the essential definition of a plan.”
While it is understandable that changes need to be made to policies from time to time, it is important that these changes be presented in a clear and concise manner. This will help to avoid confusion and allow members to make necessary adjustments ahead of time.
Permanent link to this post (300 words, estimated 1:12 mins reading time)
Tags: deductibles, health insurance, individual health, premiums
Posted in Federal, General, Laws, Resources, State, Tools | No Comments »
Thursday, December 8th, 2011
In an effort to give consumers more knowledge when it comes to premium rate increases, the Department of Health and Human Services can now require that all insurance carriers file their rate increases online via a government website -http://companyprofiles.healthcare.gov. As of September 1, 2011 insurers who plan on raising their rates 10% or more must not only provide the rate detail, but the reasons justifying the need for such an increase. This information will now be made available to consumers, allowing them to not only be made aware of premium changes, but also allow them an option to add their questions, concerns, and comments – giving them a voice where previously they felt powerless to fight against the insurance companies. It also allows them to make more educated decisions when choosing to purchase a policy with a company, or move to another more competitive carrier. During a time when most Americans are struggling while big corporations continue to reap in big profits, holding them to some accountability is a big relief.
Tags: health care costs, health insurance, premiums
Posted in Federal, General, Government Run Health Plan, Laws, Resources, State, Tools | No Comments »
Thursday, December 1st, 2011
Assembly Bill 52, the bill that would allow California officials to regulate health insurance rates, did not gain enough support from the Senate, and has been put aside for now. Assemblyman Mike Feuer (D) said that he would wait until next year before trying to pass the bill again. Fears of AB 52 reigned mostly from health plans, doctors, and hospitals, fearing that the low premiums would mean lower reimbursement rates along with increased bureaucracy and red tape. The president of the California Association of Health Plans stated “AB52 hit a major roadblock because it’s flawed. It failed to address the underlying pressures that drive up the cost of coverage”.
Tags: health care costs, network provider, reform laws
Posted in Federal, General, Laws | No Comments »
Thursday, November 24th, 2011
Recently, the autism insurance reform bill was passed, and SB 946 will be signed into law by Governor Jerry Brown. This means that as of July 1, 2012, services will be subject to the mental health parity law and require that health plans subject to this bill provide coverage for treatment to “develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder or autism.” Such programs that will fall under behavior health treatment are applied behavior analysis, occupational therapy, and speech therapy. Benefits for such therapies cannot be subject to age limits or dollar limitations.
Much of this is thanks to the organization called Autism Speaks, as they have been a strong force in pushing legislators to bring the law to fruition. While many families were faced with paying for medical care and much needed therapies out of their own pockets, this bill will help them get the care they need. Visit Autism Speaks to learn more, and urge Governor Brown to sign this bill as quickly as possible.
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Tags: added benefits, health care costs, health insurance, pre-existing
Posted in Federal, General, Laws, Resources, State | No Comments »
Tuesday, September 13th, 2011
Health care administration under the Affordable Care Act is tricky enough, but none more so than in California. Currently there are two options for the golden state – either consolidating into one regulatory agency or combining between two agencies, the California Department of Insurance (CDI) and Department of Managed Health Care (DMHC), to properly maintain a system that will ensure consumer protection. Those supporting consolidation believe that the fewer hands in the pot will avoid confusion and conflicting interpretations of federal laws. Oversight between two entities can also result in added government and administrative burdens, and difficulty in monitoring what is being purchased and sold in the marketplace.
This is a preview of
Health Insurance Regulation in California Under Health Care Reform
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Tags: group health, health care costs, health care reform, premiums, Universal Health Care
Posted in Federal, General, Government Run Health Plan, Group, Laws, Resources | No Comments »
Friday, August 12th, 2011
All of us are finding that our dollars are not going as far as they used to, but none are feeling the hit as much as senior citizens. It is shown that senior citizen’s expenses are rising twice as fast as their Social Security checks, and as many use this as their sole means of income, this is a frightening statistic. As a means to combat this gap in living expenses versus check totals, the Social Security Department created the Cost of Living Adjustment (COLA) in 1975. COLA was intended to be an automatic yearly increase based on the Consumer Price Index (CPI), and proved to be consistent until 2010. However, over the last two years, our senior citizens have received no COLA on their monthly checks.
With cost of living expenses far outpacing the calculated percentage of the CPI, many are lobbying for a review on this process. Currently, the Consumer Price Index is calculated via urban wage earners for all age groups. However, this does not take into account the higher costs for health care and other expenses older Americans need. As a means to more accurately gauge COLA, it is proposed the government use the spending patterns of seniors by means of the CPI for Elderly Consumers, and use this information to balance their checks accordingly.
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Tags: health care costs, medicare, medigap, wellness
Posted in Federal, General, Laws, Resources, Seniors, Tools | No Comments »
Friday, August 5th, 2011
Whether you are for it or against it, health care reform marches on. As states scramble to either fight the constitutionality of the bill, or create models for health care administration, January 1, 2014 edges ever closer and brings with it the start of health insurance exchanges. These exchanges are proposed to be implemented by January 1, 2014. In theory, these exchanges purport to provide individuals and businesses the same buying power as larger companies by pooling risks and premiums. However, how these exchanges operate remains to be seen.
Tags: health care reform, health insurance, individual health, Universal Health Care
Posted in Federal, General, Government Run Health Plan, Laws, Resources, State | No Comments »
Friday, February 25th, 2011
Starting this month, new protocols were implemented to regulate waiting times for California residents. These guidelines were primarily designed for HMO patients, but do extend to PPO’s as well. As it seems that more time is spent in the waiting room rather than with the doctor, these wait times provide some much needed relief. For the first year, the California Department of Managed Care will oversee that the rules are strictly followed, and health plans that fail to meet the wait times will find that they face possible fines and penalties. As it will be the insurer’s responsibility to meet the guidelines, it will also force the expansion of their provider networks to meet the need for timely care. The rules note the following maximum wait times:
Tags: health insurance, HMO plan, network provider, ppo
Posted in Employees, General, Laws, Resources, State | No Comments »
Thursday, December 23rd, 2010
With health care reform came certain guidelines that would be implemented right away. One provision states that health plans must cover preventive care at 100% – with no cost sharing (i.e. co pays, deductibles, or coinsurance). However, does this mean you can rush out to take care of all those things you have been postponing? Well, yes and no, as many items listed under the government’s guidelines are age and gender specific. Add to that the need to ensure your provider codes the preventive care correctly so it will be covered completely, this can get tricky. Here are some important things to note once your plan has added the preventive care benefit on your plan:
Tags: health care reform, health insurance, preventative care, Universal Health Care
Posted in Employees, Employers, Federal, Government Run Health Plan, Laws, Resources | No Comments »
Thursday, December 9th, 2010
While the Patient Protection and Affordable Care Act (PPACA) requires that plans remove annual and lifetime limits on plans, many part time and seasonal workers are now faced with the possibility of losing their medical coverage altogether. Many large employers, such as Disneyland and McDonald’s, do make an offer of some very basic coverage for their part time and seasonal workers, such as a plan that may only offer a few thousand dollars of medical coverage. While this doesn’t sound like much, some feel it is better than having no medical coverage in place at all, as many of these employees don’t qualify for the comprehensive full time medical plan, and would not qualify for other plans due to pre-existing health conditions. A few thousand dollars, albeit no good in the event of a catastrophic illness or accident, would at least provide incentive to seek basic preventive care on an annual basis.
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Mini Medical Plans Face Extinction Due To Health Care Reform
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Tags: group health, health care reform, health insurance, preventative care
Posted in Employers, Federal, Group, Laws | No Comments »
