Archive for the ‘State’ 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.
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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, 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 »
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 2nd, 2010
Governor Schwarzenegger recently signed two bills (SB 900 and AB 1602) which puts California at the forefront of establishing health insurance exchanges. Although these exchanges won’t be open for business until 2014, this bill will start California on the road to implementing this vital piece of health care reform. Federal guidelines do outline how the exchanges work, but each state is allowed leeway to create the exchange to work with their individual state’s needs. Proponents of this bill believe that as California becomes the first state to being the framework, it is expected that other states will be looking to California’s model for guidance in how to create their own structures. Opponents fear that this surely means an increase in taxes and fees.
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Calfornia First In Line To Set Up Health Care Exchanges
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Tags: health care reform, health insurance, heath insurance, Universal Health Care
Posted in Government Run Health Plan, Laws, Resources, State, Tools | No Comments »
Sunday, February 14th, 2010
Recently, the California Department of Managed Care has released some new guidelines for HMO patients, in order to create a more efficient and comprehensive level of care for these patients. Among the new rules:
• A physician appointment within 10 business days of a request
• A specialist appointment within 15 business days of a request
• An urgent care visit within 48 hours of a request
• Telephone access to a health care professional at all times.
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California's Timely Access to Medical Care
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Tags: health insurance, HMO plan, network provider
Posted in Employees, Employers, Family, General, Individual, Laws, Resources, State | No Comments »
Tuesday, February 2nd, 2010
Health Care reform faced yet another setback as Massachusetts State Senator Scott Brown received 51.9% of the vote needed to fill late Senator Kennedy’s seat in the US Senate. This now makes the Republican head count 41, thereby bringing the 60-count Democrats were relying on to pass the health care reform legislation to an end. Brown’s strong statements regarding the negative portions of the bill, such as higher taxes and the destruction of jobs, played a major role in his political success. However, ironic that he fills the seat of a major proponent of universal health care, many are breathing a sigh of relief as the thought is while health care reform is much needed, it is something that needs to be dealt with carefully – not a “fix it later” attitude.
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Brown's Victory & What it Means for Health Care Reform
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Tags: health insurance, individual health, Universal Health Care
Posted in Federal, Government Run Health Plan, Laws, State | No Comments »
Wednesday, September 23rd, 2009
California children will not be losing their Healthy Families coverage thanks to the implementation of Assembly Bill 1422. Over 600,000 children were going to be disenrolled starting October 1st, due to a lack of funding. Currently, there are 71,000 children on the waiting list since enrollment was frozen in Mid-July. Parents and guardians can breathe a sigh of relief, however, as this affordable medical, dental, and vision coverage will remain in place.
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Healthy Families Program Spared Massive Cuts
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Tags: children's health, health insurance, preventative care
Posted in Family, Individual, Laws, Resources, State | No Comments »
Tuesday, September 8th, 2009
The State of California has been in financial crisis as of late and now is going to hit home for many families whose children are enrolled on the Healthy Families program. This is a low cost state run plan that offers affordable medical, dental, and vision coverage for California children. Unfortunately, due to a lack of financial support from the state, they are planning on disenrolling children from the program starting October 1, 2009.
Budget cuts that totaled over $128 million dollars caused a major financial strain, and further enrollments were halted this July. This resulted in a waiting list of over 55,000 children, and a prediction of the removal of nearly 670,000 children having to be removed from coverage.
It is important to keep updated on these proposals, to ensure that California’s children maintain comprehensive medical, dental, and vision care. With too many children already forgoing vital preventative care, we have to find a way to keep our future healthy. Please visit the California Major Risk Medical Board for updated information and ways to become involved.
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Tags: health insurance, preventative care
Posted in Family, General, Individual, Resources, State | No Comments »
