Consumers are growing frustrated as they find their current doctors aren’t included in new Covered California individual and family plan (IFP) health insurance networks. There is also widespread uncertainty about the rules of in-network providers with the new Exclusive Provider Organizations (EPOs) and California’s new 19 pricing regions. When California consumers are craving information the doctors have been silent and the insurance companies along with Covered California are providing scant information.
Covered California had high expectations for 21st century e-commerce technology but agents and consumers have resort to 19th century pen and paper. There has been an avalanche of paper applications into Covered California significantly slowing down the verification and enrollment process. The sluggish processing of applications means that some families may not have insurance coverage on January 1, 2014 as promised.
Covered California announced a marketing campaign aimed at the Lesbian, Gay, Bisexual and Transgender communities to encourage them to enroll in new ACA health plans through the exchange. The print media and billboard advertising is in addition to grants to LGBT organizations to provide outreach and education.
Compared to existing small group quoting and enrollment systems from the insurers and the Cal Choice private exchange, the Covered California SHOP program seems a little clunky and unfinished. If an employer wants to realize the tax credits for contributing to employee health insurance premiums they have to have a small group plan through Covered California. Except for the option to purchase pediatric dental plans for dependent children, SHOP offers no adult dental or vision insurance.
Medicare Advantage plans have been encouraged by the Centers for Medicare and Medicaid Services (CMS) to include $0 copay prescription costs for medications that work to reduce heart attacks and strokes in the plans for 2014. Some plans will be including $0 copay drugs that fight high cholesterol and high blood pressure.
Provisions within the Affordable Care Act will reduce accidental pregnancies that are at a higher risk to be aborted. With the increased availability of no cost contraception to women, pregnancies will be planned and abortions reduced. In addition, the financial uncertainties of carrying a pregnancy to term will also be reduced as all health plans will cover maternity benefits.
The Affordable Care Act and Covered California have made it very clear that undocumented immigrants can not purchase health plans through the new market place or receive tax credits to reduce monthly health insurance premiums. There are a number of different categories of immigrantion status that do qualify individuals and families to receive premium assistance to help pay for health insurance.
Anthem Blue Cross California has released information regarding the coverage of medically necessary procedures to treat gender identity disorder, commonly referred to as a person being transgender. Effective immediately, all new and grandfathered plans will cover surgeries, hormone therapy and counseling associated with transitioning from the birth sex to the sex the individual identifies with.
While western medicine has made tremendous progress in reducing infant and mother mortality, we have also cultivated stereotypes and assumptions about the delivery of a baby that can be a disservice to the mother. Physicians and hospitals have perpetuated a myth that women can’t deliver a baby on their own and it is only safe to give birth at a hospital. Participants in this medical fantasy have also lobbied governments for laws giving them a near monopoly on for the reimbursement of maternity services limiting financial access to midwives and doulas.
I’ve dealt with my fair share of physical pain over the years and am not given to visiting a physician unless it involves blood. However, when I started to bend over and fall to my knees with abdominal pain, I figured my body was telling me something. The doctor ordered a routine stool test to check for cancer which came back negative. It was at that point that I knew I had to change my diet or continue to cramp up and fall to the floor in an impromptu prayer ritual.