The calendar of events on the Keep Dignity Health website states that by October 17, 2021, all Dignity providers and hospitals will be out-of-network with Anthem Blue Cross. The contract termination would include Medicare Advantage plans and other HMO groups. The complete termination with Blue Cross assumes that there will be no resolution to the contract dispute. Dignity Hospitals will still be in-network for life-threatening emergency care.
Health Care Insurane Coverage
Posts related to coverage, prescription medications, benefits and providers under health insurance plans.
In California there are 32 different Part D plans offered by 11 different insurance companies. One plan sponsor offers six different plans. The only thing that differentiates these plans at first glance are the marketing names like Basic, Choice, Classic, Enhanced, Plus, Saver, Secure, and Value. These monikers are marketing gimmicks and tell the Medicare beneficiary nothing about the benefits of the plan.
May 15, 2019: Tuesday night, Wednesday morning experiencing horrible pain in left shoulder, the worst in days, could not sleep. Left arm shoulder very weak in terms of raising it above my chest, usually need the right hand to help it. Turning my neck does not increase the pain. Moving my arm in different positions is what really hurts. Just resting at night, the shoulder throbs and I get some sharp pains when I try to move it into another position. Sitting upright seems to help the most. Spent hours sleeping in a chair for relief.
In 2019 I decided to get the shingles vaccine. I figured that since I had never had a reaction to the flu vaccine, nothing would happen other than a hoped for suppression of another bout with shingles. Two weeks after the first vaccine injection I had a raging sinus headache for days. My doctor said it was allergies and prescribed Flonase. Then my shoulders started to get weak. Within a couple days my whole body was itching, head to toe.
Requiring health insurance policies to cover medically necessary prevention, diagnosis, and treatment of all mental health conditions, as well as substance use disorders, that are listed in the most recent version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the mental and behavioral disorders chapter of the most recent edition of the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD-10).
Unbeknownst to many people, most California health plans cover emergency care anywhere in the United States and treat it as if it were in-network. This means that if you have a Silver 70 plan and are rushed to the emergency room of the nearest hospital while on vacation in upstate New York, your copayment will be $400 just as if the emergency services were performed at your local home office.
All of the out-of-pocket drug cost the consumer pays goes toward pushing them through the coverage gap and potentially into the catastrophic phase. These costs would include any deductible, copayments and coinsurance of the initial coverage phase, and the 25 percent coinsurance in the coverage gap. However, in the coverage gap, the consumer’s accumulated dollar amount is credited with the drug manufacturers 70 percent discount on brand name drugs.
Part of the confusion has been generated by the fact that Covered California added a special income field for reporting the federal Pandemic Unemployment Compensation (PUC) amount after many people had already enrolled. Some people enrolling shortly after they lost their jobs and employer-based health insurance due to the Covid-19 shut down, only entered their California unemployment insurance. Other households included both State and PUC amounts in one weekly amount or separate entries in the old Covered California income section.
Blue Shield of California is taking additional steps to remove barriers and help its members receive the health care they need during the coronavirus (COVID-19) pandemic, announcing today it will cover members’ coinsurance, copayments and deductibles for COVID-19 medical treatments through May 31, 2020.
The FAQs released today detail existing federal rules governing health coverage provided through the individual and small group insurance markets that apply to the diagnosis and treatment of COVID-19. The FAQs clarify which COVID-related services, including testing, isolation/quarantine, and vaccination, are generally currently covered as EHBs in these markets. The purpose of the FAQs is to provide guidance to Americans enrolled in individual or small group market health plans, including HealthCare.gov consumers. As questions and issues continue to come to CMS, they will be addressed and added to these FAQs.