Posts Tagged ‘individual health’

Use of Retail Clinics on the Rise

Tuesday, January 31st, 2012
Retail clinics, which are walk-in medical clinics found in supermarkets, drug stores, and pharmacies is on the rise among young healthy people. Not only are these facilities available more often than typical doctor’s offices, they are usually staffed with nurse practitioners and physician’s assistants, much like their typical doctor’s office for non-severe illnesses. Most cases were seen for minor conditions, such as coughs, colds, and sinus infections, and expressed that should the clinics not be available to them, they were not likely to seek out the care with their primary care physician. This is not only due to convenience; it also was shown that these costs were 30% to 40% cheaper than their doctor’s office, and up to 80% less expensive at the emergency room. With a drop in general practitioners nationwide, this also may be a reflection on the need for more providers in these fields. However, as long as access to inexpensive and quality care is available, people will seek out means that are easily fit into their hectic schedules.

 

In this day and age where every minute counts, and we are constantly on the move, being able to seek out quick care at the drop of a hat is priceless.

Increased Deductibles Results In Lawsuit Against Anthem Blue Cross

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.

Health Insurance Exchanges

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.

Anthem Blue Cross Implements Paramedical Exam Requirement

Monday, July 18th, 2011

 

As part of their medical underwriting review requirements, Anthem Blue Cross has starting using a paramedical exam as part of the application process. These in house exams will be required for any applicant age 55 and older who have not been seen by a physician in the last twenty four months, as well as anyone age 30 to 54 who have not seen a physician in the last five months. These exams will be performed at no cost to the applicant, and are intended to provide the most up to date and current health status of the individual.

Blue Shield Ends 12 Month Rate Guarantees

Thursday, October 28th, 2010

Anthem Blue Cross Introduces Retail Health Clinics

Monday, August 9th, 2010

Anthem Blue Cross recently announced that they have extended their provider network to include retail health clinics. These are walk-in clinics, albeit small, that are conveniently located in many of your local retail outlets, such as pharmacies and supermarkets. Rather than making an appointment with your primary doctor for such common illnesses as sore throats, coughs, colds, or minor fevers, you can walk into any of these clinics for an immediate exam and treatment plan. Clients who have utilized these services state that most visits take less than 15 minutes, and also include wellness and prevention services (immunization and screenings).

Overage Dependent Coverage Hits a Snag

Monday, August 2nd, 2010

Though many insurers have implemented the law early, which states adult dependents may remain on their parent’s plan until the age of 26, there have been a surprising number of employers who opted out of the earlier implementation of this law. Instead, they are waiting until they are legally required to do so – January 2011. Even though provisions of this law take effect September 23, 2010, employers do not have to comply with this until the New Year.

Pre-existing Conditions and California Residents

Thursday, July 8th, 2010

Startling news shows that one in five California residents (under the age of 65) have a “pre-existing” condition, which could render them ineligible for coverage, or offered premiums at inflated rates. Though health care reform promises all Americans coverage by 2014, this still leaves many without the coverage they need for years. What is considered a pre-existing condition? Pretty much anything you have been treated for, or are currently under treatment for prior to applying for coverage. While not all conditions will result in your denial for coverage, it can result in an increase in the monthly premiums from 20% – 100% higher. If you had a lapse in coverage, but are approved for coverage on a new plan, there may be a waiting period of 6 months before anything relating to your pre-existing condition will be covered by your insurance plan. The good news is as of September of this year, children under the age of 19 cannot be denied coverage due to their pre-existing conditions.

Insurers to Offer Overage Dependents Coverage Earlier Than Anticipated

Tuesday, May 4th, 2010

As planned during six months following the signing of the health care reform bill, coverage will be extended for dependents up to the age of 26. This will allow parents to continue to offer health insurance coverage to their dependent children, even if those children do not live in the same household. This also holds true for young adults under 26 living out of state, and those that are married. Basically, unless they are offered employer sponsored health insurance, they can continue to remain on their parent’s coverage.  

Maternity Coverage – Important Notice

Thursday, April 15th, 2010

 Important news for our Anthem Blue Cross clients in California who are on non-maternity plans! Prior to June 1st, 2010, if you became pregnant while on a plan with no maternity benefits, you would be offered their high deductible PPO Share 5000 plan. However, now that this is no longer the case, it is extremely important we evaluate your current situation to ensure coverage is in place when you need it.  

Did you know that a C-section can cost around $30,000? Or that a premature baby can run up hospital bills in the $600,000 range? This only demonstrates the importance of making certain you are covered before becoming pregnant.  


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