Archive for the ‘State’ Category

California’s Timely Access to Medical Care

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.  

The state is giving health plans one year to comply with these new regulations. After the one year grace period, non-compliant carriers will face heavy fines. With the implementation of these new rules, it is hoped to reduce emergency room traffic, as more patients are able to obtain urgent care visits instead, as well as the overall reduction of appointment wait times (which benefit all patients – HMO and PPO alike).  

Opponents to these new regulations feel that this adds to an already strained system of primary care physicans, who are already in shortage. Fears also lie in the fact that the doctor would now be forced to spend less time with each patient. However, with the average waiting time to see a general practitioner at 20 days, it does seem that the pros outweigh the cons with these timely-access rules.

Brown’s Victory & What it Means for Health Care Reform

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.  

While Brown’s win does not mean this legislation is dead in the water, it will mean that it goes back to the drawing board, where hopefully a system that works for all will come to light.

Healthy Families Program Spared Massive Cuts

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.  

This bill works in numerous ways to utilize taxes, donations, and cost sharing to avoid dropping children from the program. First, the First 5 California Commission, which oversees children’s health and educational programs via tobacco tax revenues, has offered to contribute more than $81 million. An additional $17.6 million is expected to be raised by implementing higher premiums for those above the poverty level, and raising copaymentsfor ER room visits, doctor office co pays, and prescription co pays. Health plans that administrators Medi-Cal benefits would see a 2.35% tax. This levy will replace the current 5.5% fee, which is expected to expire in October.  

With all of the above and more, let’s hope this eases the financial burden on this program, and avoids having any child go without the coverage they need.

Healthy Families Coverage Losing Financial Support in California

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.

SB 810 (LENO) The California Universal Healthcare Act

Wednesday, July 1st, 2009

Senate Bill 810, the Universal Health Care Act, proposes methods to provide affordable and attainable healthcare to all Californians. In a time where there are more uninsured individuals than ever before, and more stringent medical underwriting requirements (leaving those with pre-existing conditions ineligible for coverage), this bill could bring some much needed relief to our strained economy.
 
Under SB 810, eligibility would be based on residency. All residents would be covered, regardless of health status, employment status, or income level. Would this mean an increase in taxes? Well, theory states that over $200 billion dollars were spent in California on healthcare last year. By utilizing this enormous cash flow already being spent on healthcare by Federal, State, and County funds, such a plan is possible. By changing the way the funds are directed, such as purchasing prescription medication and durable medical equipment in bulk, California can save billions in the first year alone.
 
Ensuring fair reimbursements to providers, allowing consumers to choose their own doctors, and relying on a shared source of financial support, may be the answer to one of the biggest issues facing our State and Nation as whole.

The Argument Against Government Run Health Plans

Sunday, June 14th, 2009

While many people think the answer lies in a Government run health insurance plan, but there is also a negative side to the theory. While the idea of health coverage for all is a dream worth pursuing, we need to make sure the quality of coverage is not sacrificed in doing so.
 
Currently, there are state and government run plans in place, such as Medicaid and children’s health insurance. While these programs benefit many people who would normally not have any coverage at all, concerns lie in the fact that there are lower reimbursement rates to providers, thus resulting in less access to doctors.
 
Obama’s plan is to allow those who have a plan they already like to keep their current coverage. However, should Employers have the choice between current higher premiums, or a lower cost option of the Government run plan, the lesser of the two would be elected. Therefore, employees would now be subject to a plan with more limited access to providers, and could possibly lose their current doctors altogether.
 
In terms of the doctor’s themselves, they may refuse the low reimbursement rates altogether and decide not to accept any insurance. Lower compensation would also means cuts in care and staff at your doctor’s office. Would-be physicians may decide to pursue more lucrative careers, instead of dealing with the red-tape of a government dictated medicine.

Insurance Policy Rescissions versus AB 1945

Wednesday, June 3rd, 2009

AB 1945 (amendment to Section 10384 of the Insurance Code) recently passed in the State of California in light of all the recent publicity from insurance policy rescission’s. This Bill “prohibits a health care service plan or health insurer from engaging in post claims underwriting, defined to mean the rescinding, canceling, or limiting of a plan contract or policy due to the plan’s or insurer’s failure to complete medical underwriting and resolve all reasonable questions relative to an application for health care coverage before issuing the plan contract or policy“.

Insurance companies are still able to retro-review policies for omission of pertinent health information. However, in order to follow through and rescind a policy, the insurance carriers must first seek approval from the Department of Managed Health Care or the Commissioner of the California Department of Insurance. This bill is intended to protect the individual in question from a biased review of their case.

There are, of course, pros and cons to this bill. Those in favor state that this bill will provide protection to patients by means of regulators who will independently scrutinize policy rescission’s, and ultimately develop a standardized application that health plans and health insurers must use. Those against state, amongst other things, that uniform applications do not guarantee success and that the rescission rate is only at about 1/10th of all individual policies.

Help for Uninsured Californians!

Wednesday, May 20th, 2009

Many Californians don’t have medical coverage, and are unable to qualify for health coverage due to pre-existing conditions. However, it is important to know that there are options you may qualify for:

Medi-Cal
 
Medi-Cal is California’s version of the federal Medicaid program.  This program will pay for health services for California residents that qualify based on income and assets.  Eligibility is determined by the Department of Health Services through its sub-agency Department of Public Social Services.

Access for Infants and Mothers (AIM)


The program is designed primarily for uninsured low income pregnant women and their infants who do not qualify for Medi-Cal.  Since individual health plans will not approve you for coverage if you are currently pregnant, this provides an excellent opportunity for coverage.

Healthy Families Program

 
This program provides low-cost comprehensive health, dental and vision coverage for children and teens up to age 19 that do not have access to insurance and cannot qualify for Medi-Cal. If the mother qualifies for AIM, the baby is automatically eligible for enrollment in Healthy Families.  

Major Risk Medical Insurance Program (MRMIP)

This program provides comprehensive health insurance for Californians who are unable to obtain coverage within the individual health market.  You are able to enroll in the MRMIP program after you’ve been declined coverage by an insurance company or health plan due to a pre-existing condition. 


© 2009 Abrams California Health Insurance Agency. All rights reserved.
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