As of April 2016, when a consumer makes their first month’s payment for their Blue Shield health plan, the money is never applied to their account.
Health Insurance
Posts related to health insurance for individuals, families, small groups, enrollment, eligibility in California, plans, coverage, benefits.
Encrypting emails to protect health insurance consumers
For independent health insurance agents, such as me, who don’t have access to an already established secure network through a large agency, we have to be more diligent in securing all the different parts of the internet communication puzzle.
Comparing VSP vision insurance from 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.
Calculating the value of the maximum out of pocket amount for health insurance
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.
Covered California supports a uniform agent commission structure
Over the course of two different letters to U.S. Department of Health and Human Services (HHS) Secretary Burwell, the Executive Director of Covered California, Peter Lee, outlined the benefit of Certified Insurance Agents to their enrollment activities and suggested there should a uniform commission structure for health insurance agents. Mr. Lee’s comments come at a critical time when many health insurance companies are reducing and even eliminating agent commissions.
Native American health plans misrepresented on Covered California
American Indians and Native Alaskans have access to special $0 cost share health plans that are available through Covered California. A recent enrollment by a member of a federally recognized Indian tribe was offered four different Anthem Blue Cross PPO $0 cost share plan where each one had a different premium rate. This is odd since regardless of the metal tier level of the $0 cost share American Indian-Native Alaskan (AI-NA) health plan, they all have the same exact benefits: zero dollar cost share for all services.
Health Insurance companies tackle fraud and abuse with new verifications
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.
Do Not Enroll in Blue Shield of California Health Plans
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.
Anthem Blue Cross Tiered PPO Hospital Coinsurance
In 2016 Anthem Blue Cross introduced their new Tiered PPO Network health plans in four counties of California. The Tiered PPO marketing literature noted the member’s cost share would be less if he or she used a Tier 1 hospital, but it didn’t indicate how much less expensive it would be.
Bronze 60 100% coinsurance after the deductible confusion
One of the most baffling health plan descriptions is the 2016 Bronze 60 health plan that states that the member is responsible for 100% coinsurance after the deductible. Most people who read this immediately shake their head and think, “I have to pay for all of my health care services EVEN AFTER I meet the deductible?” There really is no reason to buy health insurance if it never helps with the costs. The second part of the equation, not always referenced, is the calendar year maximum out-of-pocket amount of the Bronze plan which does limit a health plan members health care expenses.
