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:
Posts Tagged ‘health insurance’
New Rules on Medical Wait Times
Friday, February 25th, 2011Many Children Going Without Mental Health Services
Thursday, January 27th, 2011As the number of uninsured children increases, a new study shows that many of these children have the added stress of an emotional, behavioral, or developmental disorder which is going untreated due to lack of access to medical care. Low income families tend to have children with higher rates of these conditions, such as ADD, autism, or depression, but do not have health coverage to assist with the mental health services they need – including counseling and medication. According to such reports as the one done by the Health Resources and Services Administration:
Children Guaranteed Health Coverage Thanks to Assembly Bill 2244
Thursday, December 30th, 2010The Patient Protection and Affordable Care Act (PPACA) states that children must be offered health care coverage regardless of their health status. As a result, almost all carriers decided to drop new “child only” plans from their portfolio, fearing that parents would only enroll their child once they became ill. However, a new bill signed into play by Arnold Schwarzenegger will bring this practice of denying any child health insurance coverage to an end as of January 1, 2011.
Preventive Services and Your Health Plan
Thursday, December 23rd, 2010With 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:
Mini Medical Plans Face Extinction Due To Health Care Reform
Thursday, December 9th, 2010While 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.
Calfornia First In Line To Set Up Health Care Exchanges
Thursday, December 2nd, 2010Governor 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.
Blue Shield Ends 12 Month Rate Guarantees
Thursday, October 28th, 2010
Grandfathered Plans and Your Options Now
Friday, September 24th, 2010What does it mean to lose “grandfathered status”? This may or may not be a concern to you. In a nutshell, this means is your plan will now have to comply with all regulations mandated by health care reform. One of the most important things to know is that along with guarantee issue coverage for all applicants, premium ratios cannot exceed 3:1. Currently, most carriers implement rate variations every 4 years — i.e. 30-34, 35-39, and so on and so on. With the reduction of rate brackets (from 8 to 3), one can only imagine that premiums for younger clients will be much higher than they currently are in order to meet this requirement.
Whooping Cough Overshadows H1N1 as New Epidemic
Tuesday, September 21st, 2010While promising reports from the Center for Disease control proclaim that the Swine Flu (H1N1) epidemic is “over”, another illness appears to be emerging as a major cause for concern. It seems that Whooping Cough, or Pertussis, has been declared an epidemic, and is the worst that has been seen in years. As of July 21, six infants in California died after contracting whooping cough. This bacterial disease ravages bodies, but affects infants most of all because they are so small. The cough itself is named for the sound one makes while trying to catch their breath between the coughing fits. Coughing fits can be so severe that one breaks blood vessels in their face, eyes, and even their brain. Vomiting often accompanies the coughing fits, and if you notice this symptom, seek medical attention. Treatment is more effective the earlier it is administered, starting with antibiotics. More severe symptoms may require fluids, sedatives, and even oxygen support. Note – even though the disease is dangerous to children, adults are just as likely to contract the illness, and it is just as important that they seek care for their symptoms early on.
Expired COBRA Subsidy Leads to Coverage Lapses
Tuesday, September 14th, 2010The COBRA subsidy program remains in limbo, and as a result many enrollees are choosing to discontinue coverage altogether. This program, which was intended for anyone terminated from September 1, 2008 to May 31, 2010, offered a 65% subsidy for up to 15 months. The subsidy, however, would be less for anyone whose modified gross income exceeds $125,000. While this is of great assistance to COBRA enrollees, anyone who has exhausted their 15 months or is newly unemployed, relief seem to be nowhere on the horizon.
