Kevin Knauss: Health, History, Travel, Insurance
Posts related to coverage, prescription medications, benefits and providers under health insurance plans.
The California Department of Health Care released a report confirming that several health plans may have had inaccurate provider directories for their member to search through. The Timely Access Report year 2015 reviewed several different measurements to determine if health plan members could obtain timely access to health care services. The report noted that 13 health plans listed Primary Care Physicians who were not in the health plan’s provider network.
Since the beginning of Covered California, many individuals and families have complained that some doctors refuse to accept health insurance purchased through Covered California. Most health insurance companies have stated that contracted network doctors can’t refuse to see Covered California members. However, Blue Shield of California seems to have changed their position on doctors refusing service. They are now stating, as of November 7th, that doctors can discriminate against individuals and families who have Covered California plans.
One of the first filters in selecting an EPO or PPO individual and family plan, either through Covered California or off-exchange, is determining if your current doctor is in-network. For all the enhancements to online doctor directory search tools, they still suck. They are not consumer friendly. Consumers are given either too many conditions to select or the provider search tool offers too little information.
Covered California has implemented several changes to health plans to increase the access of doctors for patients. All EPO and PPO members will be assigned a Primary Care Physician and they have lowered the office visit copay for most plans, in addition to the no cost office visits for preventive care. But the one accessibility challenge that has not been addressed is the office hours of most doctors. It would make far easier for health care consumers to get care if they could visit their doctor in the evening or on weekends.
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.
It is a reasonable expectation to assume that when a family enrolls in a health plan through Covered California that there will be local doctors to address their health care challenges. Unfortunately, some health plans have a virtual vacuum of providers in fairly large communities. This is the case for members of Anthem Blue Cross PPO individual and family plans in Livermore, California. For one family, the nearest in-network pediatrician is over 15 miles away from their Livermore home.
Suicide is a worldwide problem that affects over a million people each year, and in the U.S. there are varying age groups that suffer. It can be difficult to know where to begin in helping someone who has attempted suicide, in part because there is such a stigma surrounding it; however, if someone you care about has attempted to harm themselves and you fear it might happen again, there are signs you can watch for and things you can do to help.
The narrow doctor networks of California’s individual and family health insurance plans are actually smaller than first thought as doctors use a bait and switch tactic to lure in patients and then bill for their services with “out-of-network” providers. The health insurance companies have little control over this practice that has a doctor listed as in-network for their health plan, but the services are actually billed by a facility that is out-of-network. This bait and switch tactic, aided and abetted by confusing online provider search tools and opaque billing statements and codes, leaves consumers paying more for health care services than they should.
Even with the Obamacare subsidies, many individuals and families still opt for the least expensive Bronze high deductible health plans. The high deductible health plans require the consumer to spend $4,500 to $6,500 in a medical deductible before any real cost sharing with the health insurance company starts. As more consumers opt for these least expensive Bronze plans more insurance companies are creating insurance products to help cover the high deductible of these plans. But are these indemnity plans worth the money and will they actually pay when you need the money?
It took me a long time to realize that the old adage of “It’s not what you know, but who you know” with respect to success was a crock of crap. Regardless of what or who you know, if you can’t produce something that people will consume, you will never be successful. The connections help get in you in the door. But if you can’t produce results, service, or products, you will be of little value to your associates.
