Kevin Knauss: Health, History, Travel, Insurance
Posts related to Health Net of California health insurance plans for individuals, families, small groups, Covered California.
As of October 2022, there were no announcements that Stanford Health Care primary physicians would be in-network with any other individual and family plans. Blue Shield HMO states that Stanford hospital is in-network, but not the physicians. Valley Health Plan can make referrals to Stanford specialist doctors, but not for primary care.
Now, it seems they have set up their communication structure in such a way as to thwart any meaningful discussion between them, agents or potential consumers. If I can’t access information for my clients, then I am not providing all the services my clients expect. If the health plan throws up barriers to my access, then it is not a functional health plan in my eyes.
This is a review of the responses to the Coronavirus Covid-19 health care issues from the websites of most of the individual and family plan carriers in California. Some websites detail the response and cost of Covid-19 health care issues better than other. They all seem to be covering Covid-19 testing at no cost. The cost of other health care services are subject to the plan benefits.
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.
Health Net is making it easier to add adult dental and vision to their off-exchange plans. They call the added dental and vision benefits the Plus package. For the EnhancedCare PPO, PureCare EPO, and PPO plans the Plus package of dental and vision benefits is $14.42 per adult. The maximum dental benefit per year is $1,000. Instead of a member cost-sharing percentage these plans have a fee schedule. For example, a filling on one tooth would be $22.
Health Net is bringing primary, preventive and urgent care right to our members — literally. Starting May 1, 2018, your PPO clients — individuals and all group sizes — will have a new way to connect to care with a Heal doctor who can make house calls.
Both Health Net and Blue Shield have wasted thousands of hours of time for consumers, agents, and their customer service staff. Tempers have become short and patience has run thin. And as of December 21st, a month after some people have applied for health insurance, 10 days before the plans are to become effective, many families don’t know if they will have insurance on January 1, 2018.
Health insurance companies are smarter than your average house cat. They have reams of data about health care claims and demographics. They can forecast, with reasonable confidence, that altering some of the member cost-sharing benefits may reduce their final exposure to pay member claims. It has also been suggested that consumers who purchase health insurance off-exchange, paying the full premium rate with no subsidy, may be more judicious in how they use health care services. In other word, off-exchange consumer mays tend to file fewer health care expense claims. This results in lower rates to the consumer.
The health plans don’t recognize the invoiced amount of the health care services from out-of-network providers as either accruing toward the deductible or for their cost-sharing of 50% before the maximum out-of-pocket amount is met. The health plans apply a Usual and Customary Rate (UCR) or the Allowable Amount. This limits their responsibility for payment and increases the health plan members costs.
The health plans and Covered California may give lip service to the value of the agent community, but it is not reflected in the compensation we receive. I’m not trying to get rich as an insurance agent. My net revenue listed on my Schedule C for 2016 was $34,000. If the new compensation schedules significantly erode my insurance revenue then I will have to find other income streams. Maybe Covered California will hire me to answer phone calls; I hear they have a great benefits package.
