Kevin Knauss: Health, History, Travel, Insurance
Posts related to Blue Shield of California for individuals, families, small groups, Medicare, Medi-Cal, Covered California.
Covered California has struck a deal with VSP vision insurance plans to offer Covered California members vision insurance. The VSP vision insurance plan is only available to Covered California members. For the bare essentials of vision coverage, the VSP – Covered California plan is very competitive when compared to other insurance plans on the market. However, there are some eye wear options that don’t have specific copayment amounts and could cost the plan member more in the long run.
All individual and family health insurance plans include a maximum out-of-pocket amount that is the most an individual will pay on in-network health care services for a calendar year. This is particularly important for sole proprietors and self-employed people as one emergency room visit can easily top $20,000, and without health insurance, can imperil the person’s business. The value of the maximum out-of-pocket benefit can be measured and compared between different metal level health plan tiers and carriers as one guide in selecting a health plan.
Health insurance companies are deploying a variety of measures to reduce fraud and abuse such as only accepting paper applications or requiring proof of residency and identity.
As of January 12, 2016, I cannot recommend any individual or family enroll in a Blue Shield of California health plan either directly with them or through Covered California. As an insurance agent I have been dealing with Blue Shield’s nightmare enrollment, eligibility, and billing fiasco for over three weeks.
Blue Shield of California’s billing system that created major headaches for individuals and families in 2014 continues to stumble into 2016. Even through changes to the enrollment website, the simple tasks of determining an applicant’s eligibility and properly applying a premium still seems elusive to Blue Shield in several instances. For whatever reasons, several of the Blue Shield units – underwriting, eligibility, billing, member services, and IT- don’t seem to talk to one another.
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.
New for 2016 is a Blue Shield individual and family health plan that offers $7 primary care office visits. The new Blue Shield of California Silver Seven 3750 PPO also has $7 lab tests as well. The trade-off for the low $7 office visits and other health care services is $3,750 deductible and 30% coinsurance for services subject to the deductible.
Blue Shield has redesigned their online enrollment website to exclude seniors turning 65 in 2016 from purchasing a health plan directly through their website. If an individual will be turning 65 years old within six months of the effective date of the plan they must apply with a paper application. The only online enrollment option is to use the Covered California enrollment website even if the individual doesn’t qualify for the ACA tax credits.
Blue Shield of California announced that they were adding University of California Medical Centers and Physician Groups as preferred providers for their individual and family, small group, and large employer health plan networks. Shortly after the initial announcement the UC hospitals and doctors were in-network; Blue Shield released another announcement to clarify that not all […]
One of the big complaints about health care services is not knowing or being surprised by the cost of medical treatment. Blue Shield of California has taken a modest step toward helping plan members determine the cost of health care services with their new treatment cost estimator tool. Initial reports from clients suggest the […]
