While the Insurance Gender Nondiscrimination Act (IGNA), also known as AB 1586, prohibits health plans from denying medically necessary health care to transgender individuals, the exact treatment options covered for individuals with gender dysphoria remain unclear in California. The determination of whether a health plan will cover a certain medical procedure to facilitate the transition to the opposite and identified sex of the health plan member hinges on the medical necessity of the procedure.
Archives for February 2014
Medicare Prescription Drug Plan finder function is great
Before you talk to any insurance agent, prescription drug plan call center or sign up for a Part D Prescription (PDP) drug plan from a direct mail advertisement go to Medicare.gov and do a plan comparison. The Medicare prescription drug insurance plans are the most complicated and confusing of all the Medicare decisions a beneficiary must make. The Centers for Medicare and Medicaid Services has built one of the best online comparison tools for evaluating PDPs.
Blue Shield exposes Social Security numbers on public web page
Blue Shield of California sent notices to their appointed insurance agents that the agent’s Social Security number had been displayed during the course of member’s online payment. The letter from Blue Shield, dated February 18, notifying agents of the breach to their private personal information does not mention how many agents had their Social Security number’s compromised. While I was not shocked to receive the letter informing me that my personal information was displayed, I was angry that Blue Shield let this happen.
Medicare sanctions CalOptima’s OneCare Special Needs Plan
Orange County Health Authority’s CalOptima OneCare Medicare Advantage plan was served a notice of immediate sanctions by the Centers for Medicare and Medicaid Services (CMS) on January 24, 2014. The immediate sanctions mean that CalOptima can’t market or enroll new members into their OneCare Special Needs Plan until the sanctions are lifted. CMS cited “widespread and systemic failures impacting CalOptima’s enrollees’ ability to access health care services and prescription medications” as a summary for issuing immediate sanctions.
Hiking down to Knickerbocker Creek, Canyon and waterfalls
The Knickerbocker creek and waterfalls are pretty spectacular, if, you can get to them. These seasonal waterfalls through Knickerbocker Canyon are fairly inaccessible because of the steep terrain. Located in the Auburn State Recreational Area Park in Cool, Ca, Knickerbocker waterfalls in the rock lined canyon make for a challenging hike/climb to an area few people ever visit.
Are Certified Enrollment Counselors prepared to answer health insurance questions?
One of the strategies for enrolling hundreds of thousands of California residents in new Covered California health plans was to have an army of in-person Certified Enrollment Counselors. While these folks are trained on how to fill out the Covered California application, they don’t necessarily have any background in health insurance or how it works. Are the Certified Enrollment Counselors (CEC) qualified to answer simple to complex questions about health insurance and will they be there next month when their client has issue?
San Juan Water District allows exclusive Granite Bay Golf Club cheap water during drought
San Juan Water District dedicated their February Board meeting to reviewing the impending water shortage created by a drought shrunken Folsom Lake and the necessity for increasing retail water rates in their Granite Bay service area. While there was discussion on potential mandatory outdoor water restrictions, non-residential customers such as the exclusive Granite Bay Golf Club seem to escape any meaningful rate increase in the proposals.
Covered California’s SHOP not ready for occupancy
The Small Business Health Options Program (SHOP) from Covered California has unfortunately proved itself to be just as inept at processing enrollments as the individual and family plan side. What promised to be a stream lined and easy process for small employer groups to offer health insurance to employees through Covered California is beset with a dysfunctional enrollment website and poorly trained support staff. They make Anthem Blue Cross’ decision not to offer plans through SHOP absolutely prophetic.
Will Covered California Medi-Cal claw back payments?
With more working Americans eligible for expanded Medicaid health insurance there is also a growing fear that some government agency will want to seize a recipient’s assets to pay for the health care expenses. Fortunately, the expanded Medicaid, Medi-Cal in California, works under slightly different rules and provides some protection against “claw back” of assets to satisfy health care debt. However, one age group may be subject to Medi-Cal estate recovery rules under expanded Medicaid.
Changing Covered California plans may be hazardous to your health
What should be a simple task of changing from one Covered California health plan to a new one is proving to be no easy switch. The Covered California CalHEERS internet based program seems incapable of handling the switch between health plans for residents. People are complaining of retroactively cancelled policies, odd effective dates and a system unable to handle simple billing issues.