Kevin Knauss: Health, History, Travel, Insurance
Posts related to health insurance for individuals, families, small groups, enrollment, eligibility in California, plans, coverage, benefits.
Kaiser is unique in that because they manage their own pharmacies, we can get a look at the ordering habits of opioids, and by extension, the prescribing of those opioids by Kaiser doctors. With a pharmacy like Costco, that has a higher ordering rate for higher strength doses of hydrocodone, it is hard to pinpoint which doctors or medical groups are prescribing the stronger drugs. It may not even be a doctor in Sacramento County.
If you take a nasty spill on your skate board in San Francisco, and have to have your ankle X-rayed at Kaiser, it will cost $102. But if you break your finger poking your political opponent in the chest, that finger X-ray will cost $111. These costs are lower in Southern California where they have more skate boards and finger poking. An ankle X-ray in Southern California will be $71 and the finger at $78. They don’t mention if there is a discount X-ray cost for both if you poked someone and then fell off your skate board.
Blue Shield has added a gender identity category to align with the new state law even though health insurance companies are not required to do so. As an organization, Blue Shield recognizes our members whose gender identity is female, male or nonbinary. We want to honor any employee, and member their wish to be recorded as the gender they identify with.
In addition to paying a $2.8 million fine, Anthem Blue Cross has agreed to a Corrective Action Plan (CAP) that represents a fundamental shift in how the plan handles enrollee grievances.
The HIPP program pays the medical insurance premiums, coinsurance, deductibles, and other cost-sharing obligations for the individual. The annual cost of the premiums and member cost-sharing is compared to the estimated cost of an equivalent set of Medi-Cal services. Outlined in in an ACWD Letter 09-02, DHCS uses a specific formula to determine the cost-effective nature of the private insurance over Medi-Cal FFS.
If you think regular health insurance is filled with loop-holes and caveats to avoid paying health care claims, read the fine print on the HCSM. It can be difficult to know if the HCSM will pay on certain claims under certain conditions. Then there is the wild card of denial because of how the injury or illness occurred that is not explicitly included or excluded in the plan. For example, if you are at a gay bar and are dancing, then trip and break your ankle, will it be covered if the HCSM does not approve of activities involving the gay community?
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.
If you have to move out of your county because of the wildfires you may be entitled to a Special Enrollment Period. California is broken into 19 different rating regions. Los Angeles County is actually two regions, 15 and 16. If you move to a different region, you have a qualifying event for a Special Enrollment Period IF you already have health insurance.
This enforcement action is a result of 21 cases involving 63 consumer grievance violations that occurred during 2014 through 2017. In these cases, L.A. Care deprived enrollees of their rights to medical care. The plan has acknowledged its failure to comply with the law, and the Department has determined that an administrative penalty and Corrective Action Plan are warranted. The corrective actions include employee training and increased oversight of the grievance and appeals system.
The Health Net PPO, not to be confused with the EnhancedCare PPO offered through Covered California, is the only plan that will give plan members access to both the Stanford doctors and hospital. These plans are only sold off-exchange or directly from Health Net. Plan enrollment is limited to certain regions and counties within California.
Kevin Knauss provides no cost health insurance rate quotes and enrollment.
Kevin Knauss, Education Before Enrollment, Health Insurance Bridge
Visit the IMK File Explorer page to find the latest documents from a variety of health plans for individuals, families, and small groups.
