Health Insurance

Posts related to health insurance for individuals, families, small groups, enrollment, eligibility in California, plans, coverage, benefits.

Are Health Insurance Apps Tracking, Collecting, and Sharing Your Data? Yes

August 25, 2022 By Kevin Knauss Leave a Comment

The extraction, storage, and manipulation of your personal online data is akin to the wild west. There are few rules in this relatively young industry and what rules there are, the app gleaners ignore until they are caught violating the law. You can’t see the digital portrait you have created by your own actions on your mobile device and captured by the health insurance apps. In a sense, they own your image. Usually images you create are protected by copyright laws. In this new industry of digital surveillance and capture, you don’t own your own image.

Blue Shield Abortion Travel Reimbursement Benefit

June 29, 2022 By Kevin Knauss Leave a Comment

While prior authorization is not required, Blue Shield of California members should become familiar with all of the conditions of the program for proper reimbursement. The abortion services must be provided by a licensed practitioner in a state other than the member’s residence where pregnancy termination can be lawfully provided.

Most California Health Plans Include Abortion as A Covered Health Care Benefit

June 24, 2022 By Kevin Knauss Leave a Comment

Does my Medi-Cal insurance cover my abortion? Yes. Is my private insurer required to cover my abortion? Yes for most people. California law is clear that abortion care is basic health care, and most insurance plans must cover basic health care services. This requirement does not apply to employers that provide “self-funded” health care coverage or grandfathered plans.

Anthem Blue Cross Fined $1.1 Million by California Department of Managed Health Care

June 9, 2022 By Kevin Knauss Leave a Comment

The plan was in violation of the law when it failed to properly exclude certain office visits from enrollee deductibles. These office visits included primary care, and behavioral health office visits. The plan agreed to corrective actions including identifying and reimbursing impacted enrollees, which includes reimbursing nearly $9.2 million to 6,561 enrollees.

How To Select A Health Insurance Plan

April 27, 2022 By Kevin Knauss Leave a Comment

Health insurance, at a basic level, is asset protection similar to car, life, and home insurance. Most health plans have an annual maximum out-of-pocket amount that limits your liability to outrageous health care bills in the event of an accident or sudden illness. Once the maximum out-of-pocket amount is met, the health plan covers all in-network health care expenses for the rest of the year.

Blue Cross Removes UC Hospitals From EPO Health Plans

February 17, 2022 By Kevin Knauss Leave a Comment

Neither Covered California nor the sample Blue Cross letter being sent to members explains why the UC hospitals are no longer in-network. Someone, Blue Cross or UC, pulled the plug retroactively to January 1. Fortunately, Blue Cross expanded their EPO network to include Sutter doctors and hospitals for 2022.

The Longest Mile: Gender Affirming Surgery and Health Insurance

January 17, 2022 By Kevin Knauss Leave a Comment

The entire process of gender affirming surgery is intimate. Perhaps the most important relationship that you’ll want to secure is with your surgeon. Your health plan (Medi-Cal, Medicare, individual & family, employer group) will have a network of surgeons in the network. With luck, your preferred providers and surgeons will already be in the network of your health plan. Each health plan maintains an online list of providers for members to search. Healthcare networks are still learning and catching up with how to provide services to the transgender community.

Will Unvaccinated Adults Increase Health Insurance Premiums?

November 30, 2021 By Kevin Knauss Leave a Comment

It is doubtful that in California individuals who remain unvaccinated would be slapped with a surcharge to cover the risk of future medical claims associated with treating a Covid-19 infection. That is not the way California approaches health insurance rates. However, the health plans can increase rates in regions that have demonstrated elevated health care costs and reasonably predict the higher cost trend to continue because of unvaccinated adults.

Blue Shield BlueCard Is Back for 2022

November 18, 2021 By Kevin Knauss Leave a Comment

The BlueCard program allows members to receive some health care services outside of California. This is an important feature for individuals who routinely spend weeks or months outside of California on business. With the exception of emergency services, if an individual needed small health care service in another state, they were almost forced to buy two health plans; one for California and one for the other state.

Do The Star Ratings for Covered Health Plans Have Any Relevance?

November 12, 2021 By Kevin Knauss Leave a Comment

Most consumers would be surprised to learn that their health plans are being rated on how well their doctors treat them. Consumers don’t want their health plan involved in their health care decisions or interactions with their doctors. Consequently, some health plans are paying for the sins of some providers by being labeled with a low star rating.

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