Kevin Knauss: Health, History, Travel, Insurance
Posts related to health insurance for individuals, families, small groups, enrollment, eligibility in California, plans, coverage, benefits.
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.
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.
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.
Even those people who hate Obamacare come running to it when they need help. A person who contacted me to clarify that he could enroll in an Obamacare plan because his Christian health care sharing ministry wouldn’t cover pre-existing conditions shows how people use these sharing ministries to dodge Obamacare and reveal their hypocrisy when they do need real health insurance.
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, 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.
Covered California has sent Certified Insurance Agents information and links on sensitivity and sales training for the Lesbian, Gay, Bi-Sexual and Transgender community. The sensitivity training presentation and social media icons were developed by Out2Enroll a national organization encouraging the enrollment of the LGBT community into Marketplace health insurance. While the overall information is good, there is underlying sales element that reduces the community down to dollar signs instead of human beings.
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.
I screwed up big time on behalf of a man with a serious illness. The end result is that he will be without health insurance for the month of December. Even though there are other people who failed in this situation, I have to take the ultimate responsibility that he might have to shoulder thousands of dollars in health care expenses that would have been covered by health insurance. I broke the business rule of never following your heart, and always trust your gut.
