While Covered California standard benefit design health plans have very specific limitations on member responsibility for in-network health care services, the coverage for out-of-network services can vary greatly between PPO health plans. The insurance carriers that offer PPO health plans through Covered California (Anthem Blue Cross, Blue Shield of California, and UnitedHealthcare) with out-of-network coverage seem to have made up their own rules for this PPO benefit. Because the Covered California individual and family health plans have such narrow networks, many families are finding that they must go out-of-network to receive certain health care services.
Anthem Blue Cross
Posts related to health insurance plans offered by Anthem Blue Cross in California for individuals, families, small groups, Medicare, Medi-Cal.
Anthem Blue Cross denies Covered California consumers agent representation
Anthem Blue Cross, following internal policies to protect agents, prevents their members from selecting their preferred health insurance agent through Covered California. The Blue Cross policy of not recognizing an agent delegation made by a household in their Covered California account prevents the selected agent from properly representing the family members and being compensated for his or her time. The Blue Cross agent of record policy occurs when the Covered California member originally enrolled with another agent or without an agent and the member is considered a house account.
Accessing benefits under dual eligible special needs plans
Anthem Blue Cross of California Medicare Advantage dual eligibility with Medi-Cal Special Needs Plans May 30, 2015 This guidance is generally applicable for all health insurance companies that offer Medicare Advantage Special Needs Plans for dual eligible beneficiaries. Dual Eligibles (Duals) are individuals who are entitled to benefits from both the federal Medicare and state-run […]
1095-A reveals excess ACA tax credits paid to Blue Cross from Covered California
Information from a consumer’s 1095-A Marketplace Statement reveals that Covered California continued to credit Anthem Blue Cross with Advance Premium Tax Credits (APTC) even after the consumer had transitioned to Medi-Cal. While there doesn’t appear to be any fraud, Anthem did receive at least $647 for an individual who was no longer a member of their […]
Anthem Blue Cross gets hit with cyber attack
Updates and announcements regarding the Anthem Blue Cross cyber attack data breach. Anthem Blue Cross, February 17th Members to get an email from us about the cyber attack To our valued business partner: We want to keep you informed about our actions in response to the cyber attack. We will begin sending emails to […]
Anthem Blue Cross includes transgender services in Evidence of Coverage
Anthem Blue Cross of California has included a section called Transgender Services in their Evidence of Coverage (EOC) documents for individual and family plans offered in California for 2015. While the seven paragraph section doesn’t provide a lot of details, it is a major step toward recognizing that individual plans must include such coverage to address the medically […]
Blue Shield and Blue Cross struggle with renewal letters to members
In the confusing landscape of health insurance regulations post ACA implementation, numerous health insurance companies have sent out renewal letters to members with errors. Blue Cross, Blue Shield, Health Net and even Covered California have had to send follow-up letters to correct erroneous information. Unfortunately, this incorrect correspondence only leads to more confusion surrounding the benefits and renewal […]
Health Net restricts provider networks on Covered California plans
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 […]
Anthem Blue Cross set to terminate 79 health plans in California
In the proposed rate increase filing with California Department of Managed Health Care (DMHC) on August 1, 2014, Anthem Blue Cross included 79 health plans that they would be terminating at the end of year. Titled Exhibit P – Terminated Plans, effective 2015, Anthem Blue Cross lists 39 pre-ACA and 40 post-ACA individual and family […]
Blue Cross waives network restrictions for Napa quake victims
Anthem Blue Cross announced that they were temporarily revising some of their health insurance guidelines for residents in Napa, Solano and Sonoma counties impacted by the Napa earthquake. Important for Anthem Blue Cross members in these counties is that they can see any physician for necessary health care, urgent care and emergency room services even […]