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.
Posts related to hospitals, costs, and coverage under health insurance plans in California.
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.
If you want to keep either UCLA or Hoag in your Oscar health plan, you will have to enroll in an off-exchange Oscar plan that is designated with the Circle network. The Circle network that includes UCLA and Hoag will only be available in the metal tier plans of Bronze and Silver.
The single payer proposals I have read deal mainly with the consumer side regarding access to care and reduced patient costs. What seems to be missing is recognition that medical groups and hospital have built their budgets around the existing health insurance plan reimbursement rates. There is no mechanism in the single payer proposals to limit the costs such as the cost of labor (nurses) which is a significant financial element for hospitals. Until we get a handle on the cost of health care, health insurance rates will continue to rise and a viable single payer proposal, where you have more than one or two hospitals participating, will only be a dream.
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.
Forcing either the health plans or the providers to post a list of costs for routine services is a very low impact way of adding consumer information to the health care market. The government is not telling the providers what they should charge. The government is not telling the health insurance companies what they should pay the providers. A law mandating a simple fee schedule like Kaiser Permanente has published will create price transparency and allow consumers to compare valuable health care cost information across a variety of health plans and providers. This will ultimately slow down the rate increases as providers compete not only on patient satisfaction, but on price as well.
The California individual and family plan market place will be changing quite a bit in 2017. Next to confirming if your favorite doctors are covered by the new health plans, many consumers want to make sure their chosen hospital is in-network as well. From information provided by Covered California and the health plans, I have put together a table of California hospitals by region and the health plans they accept.
With the announcement that Blue Shield of California may be dropping Sutter Health physicians and hospitals from their list of network providers in Northern California, Blue Shield members are wondering if their health plans are any good. For all the good of health care reform under the Affordable Care Act consumers are learning that doctors […]
While Covered California was preparing a large press announcement with the California Medical Association (CMA) about extolling the number of physicians that are participating in Covered California individual and family health plans, Health Net was releasing their list of providers in their new narrow network Exclusive Provider Organizations (EPO) and Health Service Plans (HSP). A search […]
There was tremendous confusion over which doctors were in-network for the new individual and family plans offered through Covered California in early 2014. While the major health insurance plans offering PPO and EPO plans maintained the provider networks were the same regardless of whether they were purchased on or off the exchange, doubts persisted fueled […]