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”.
Posts Tagged ‘network provider’
Assembly Bill 52 Hits a Roadblock
Thursday, December 1st, 2011New Rules on Medical Wait Times
Friday, February 25th, 2011Starting 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:
Doctors Face Major Cuts in Medicare Reimbursement Rates
Monday, August 16th, 2010The American Medical Association is working diligently to fight the cuts in Medicare reimbursement rates, which is about 21% less than current compensation rates. Though the House delayed the cuts via HR 3962 (Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010) until at least November of this year, many physicians see this as only a temporary fix to a flawed system. Congress states they have no other choice, as mounting deficits play a role in their decision. Medicare overall is in a difficult financial state, leaving little to no room for improvements. The only choice doctors will have, other than dropping Medicare patients altogether, will be getting more patients in the door. Either way, patient care will be compromised if the Medicare pay cuts occur.
California's Timely Access to Medical Care
Sunday, February 14th, 2010Recently, 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.
Reduced General Practice Physicians in California
Monday, July 6th, 2009Recent studies show an alarming trend in California. General Practice physicians are in dwindling supply, and at the lower end of “per capita need”. As fewer and fewer younger physicians enter this field, the inadequacies will become even more dire. On the other hand, specialists seem to be in abundance, but are not distributed throughout the state in an equal manner. Both Specialists and General Practice doctors tend to congregate more in the urban areas, leaving the rural areas without the medical care they need. Add to that the insult of few new general practice recruits, and their current provider population getting older, these individuals can be in real trouble.
Hopes for getting a quick and long term recovery would mean a few things from the state. The first step, of course, would be to get more physicians to study in the field of primary care. This can be done with the help of grants, financial support, and better residency training programs in all fields of general medicine. Providing financial compensation to these new primary care providers would also help to establish care where we most need it. By making it easier to practice in the hard hit areas will ensure that no Californian is without the physicians they need. The only way to achieve this, however, is to make sure that both the patient and doctor are adequately taken care of.
What Does Concierge Medicine Mean?
Friday, May 22nd, 2009 These days you are probably hearing a lot about “concierge medicine”. This is where physicians charge patients an annual fee of several hundred to several thousand dollars a year to ensure benefits like longer appointments, shorter waiting times and the ability to call your provider directly. It has been reported that there are over a thousand physician groups nationwide who are currently operating concierge practices.
Critics claim that these practices result in many patients being driven to emergency rooms and family doctors who remain independent, resulting in overcrowding and long stays in the waiting room. Since there are fewer doctors going into primary care, this too will only add to an already strained system.
What is the Real Cost of Non-Network Providers?
Tuesday, April 21st, 2009Many people will find themselves in the position of dealing with a non-contracted provider.
What will this mean in regards to your insurance coverage? Depending on your plan, you may find that you now have little to no coverage for these procedures.
For example, many PPO plans will state that they cover 50% on non-network procedures.
However, it is important to realize that this means that they cover 50% of the allowable amount, rather than 50% of the overall procedure. Example:
Say you see a non-network provider and receive $1000.00 worth of care. The insurance company’s allowable amount for this procedure is $400.00.
