The Paragon Health Institute report on fraud in the ACA enrollments is flawed and biased. The report does highlight the desperate need for affordable health insurance in many states that have not expanded Medicaid.
Health Insurance
Posts related to health insurance for individuals, families, small groups, enrollment, eligibility in California, plans, coverage, benefits.
Jericho Share Health Care Sharing Ministry Fined, Ordered to Shut Down
Jericho Share, a purported Health Care Sharing Ministry, fined and ordered to cease operations in California.
Kaiser Covered California Billing Problems
Covered California consumers who enrolled on or after February 18, 2024, should confirm they paid their initial payment online or contact Kaiser Permanente at 888-236-4490 to make a payment to effectuate their coverage.
Blue Shield, Fix Your Billing System
Had you been near this family’s home, it would have sounded like an explosion as the Blue Shield member vented to me about the incompetent billing system of Blue Shield.
Blue Shield Fined For Transgender Health Care Claims Processing
In March of 2021, Blue Shield approved the plan member to receive gender dysphoria health care services from an out-of-network provider. Unfortunately, Blue Shield, according to the press release, inappropriately adjusted several of claims submitted by the health care professional. The payment dispute led to the health care professional suspending continued treatment until the claims dispute was resolved.
Inland Empire Health Plan for Covered California
IEHP appears to have very competitive rates for the Bronze and Silver metal tier health plans. They are less competitive at the Gold and Platinum levels. IEHP is the primary Medi-Cal managed care plan for the 2 counties. With the end of public health emergency, many Medi-Cal beneficiaries may no longer be eligible and will be transitioned to Covered California private health plans with the health insurance subsidies.
Unexpected Costs of California Health Plans in 2024
Silver 73, 87, and 94 health plans, available through Covered California based on household income, have no medical deductible. That does not mean you escape any patient responsibility for health care services subject to coinsurance. With the enhanced Silver plans, you go straight into the coinsurance percentage for inpatient hospitalization and skilled nursing facility stays because there is no medical deductible.
Insurance For Your Health Plan Deductible
There are a couple of different models of the deductible insurance plans. All of the designs require the individual to meet a deductible between $1,000 to $2,000. The plan’s deductible are health care expenses you must pay before the deductible insurance is triggered. Also with the models are two different maximum benefits of either $4,000 or $6,000. In other words, the plan will cover either $4,000 or $6,000 in health care expenses in a calendar year.
Why Are PPO Health Plans So Expensive?
PPO and EPO plans generally have a larger network of hospitals and medical groups. They will include popular providers such as Cedars Sinai, Hoag, Providence, Sutter, and UC hospitals and medical group. The members of PPO and EPO plans can travel great distances to see their favorite specialist.
Health Insurance as Asset Protection
The cost of major surgeries or cancer treatment can easily top out at $100,000 or more. The health insurance with a maximum out-of-pocket amount limits your liability so you do not have to liquidate your assets to pay the doctor and hospital bills. Health insurance protects your assets.
