Kevin Knauss: Health, History, Travel, Insurance
Posts related to health insurance for individuals, families, small groups, enrollment, eligibility in California, plans, coverage, benefits.
Blue Shield of California, as well as other health plans, would like to break away from the large Pharmacy Benefit Managers and some of their distorted incentive and pricing structures. Unfortunately, the Pharmacy Benefit Managers perform many tasks involving price negation, handling the payments process from pharmacy to health plan, and managing the pharmacy network.
We will see some health plans not be offered if there is a parallel marketplace with non-subsidized plans that have gaps and caps. Healthy people will migrate to the lower cost health plans leaving people who need health care services in the subsidized plans. This will cause the death spiral of the health plan as claims expenses increase with shrinking premium dollars.
The goal of the program is not to have parents or legal guardians have to pay out-of-pocket for covered services and hearing aids. However, if the family has other insurance, the provider must bill that health plan first, which may require some initial costs by the family. After the private health plan has paid their share, HACCP will supplement the remaining costs.
The virtual PCP can refer to an in-person specialist. The goal for Blue Shield’s virtual PCP implementation is to reduce wait times to see a physician and reduce costs to the plan and member. Behavioral health will also be a part of the Accolade Care virtual system as well as a health coach. PPO plan members will also be able to select an Accolade Care virtual PCP.
All of the categories of health insurance premium assistance – Individual and Family, Medicare, Employer Sponsored – can also help with out-of-pocket health care expenses. The programs will cover expenses that accrue to meeting the maximum out-of-pocket amount of the health plan. These costs include copayments, coinsurance, and deductibles, all of which add towards the maximum out-of-pocket amount.
Not all the below options may be available to you because some are contingent on your age, employment, or income. Those health insurance alternatives available to you are worth investigating and considering if they meet your budget or adequately address health care challenges you may be facing.
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.
The Paragon Health Institute report on fraud in the ACA enrollments is flawed and biased. The report does highlight the desperate need for affordable health insurance in many states that have not expanded Medicaid.
Jericho Share, a purported Health Care Sharing Ministry, fined and ordered to cease operations in California.
Covered California consumers who enrolled on or after February 18, 2024, should confirm they paid their initial payment online or contact Kaiser Permanente at 888-236-4490 to make a payment to effectuate their coverage.
