Kevin Knauss: Health, History, Travel, Insurance
Posts related to doctors and health insurance plans, in-network, and their support of health care reform.
The Stanford Health Care hospitals and facilities contract with Blue Shield ended on June 28, 2024. Despite many months of good faith negotiations with Stanford Health, we have not been able to reach a reasonable agreement on reimbursement rates and contractual terms that are beneficial for both parties and keep care sustainably affordable for our members.
Whether you purchase your health insurance through Covered California or off-exchange direct from the carrier, you can use the Covered California Shop and Compare tool to search for doctors and hospitals. The Covered California provider search tool will display the network status of the doctors and hospital you select for all the different plans offered.
Health insurance, at a basic level, is asset protection similar to car, life, and home insurance. Most health plans have an annual maximum out-of-pocket amount that limits your liability to outrageous health care bills in the event of an accident or sudden illness. Once the maximum out-of-pocket amount is met, the health plan covers all in-network health care expenses for the rest of the year.
Most consumers would be surprised to learn that their health plans are being rated on how well their doctors treat them. Consumers don’t want their health plan involved in their health care decisions or interactions with their doctors. Consequently, some health plans are paying for the sins of some providers by being labeled with a low star rating.
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.
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.
By the time I had all the fun in the urologist’s office, the prostate pain had virtually disappeared. My PCP and I had theorized before the PSA test that the new mountain bike I bought, with the knife-like seat, may have traumatized the pudendal nerve, a common problem among cyclists. I had stopped riding my new bike and the pain gradually subsided. The next PSA test result was a 4, confirming that I needed to buy a new bike seat.
Health Net is bringing primary, preventive and urgent care right to our members — literally. Starting May 1, 2018, your PPO clients — individuals and all group sizes — will have a new way to connect to care with a Heal doctor who can make house calls.
Because of all of the numerous ways a provide network search can give incorrect results, I am now recommending that people print out a list of providers in their area. Usually the list can be created in a PDF format that is searchable with Adobe Acrobat Reader. You can look through the list of doctor names alphabetically. You might see Dr. Balabat and realize that is your doctor when you thought the name was spelled Baladat.
Before I start gathering coverage information, I create a table with preferred or “must have” providers, hospitals, and drugs in rows, with the available health plans across the top columns. I then mark which health plan has the providers in-network and if the drugs are covered and at which Tier.
