The single payer proposals I have read deal mainly with the consumer side regarding access to care and reduced patient costs. What seems to be missing is recognition that medical groups and hospital have built their budgets around the existing health insurance plan reimbursement rates. There is no mechanism in the single payer proposals to limit the costs such as the cost of labor (nurses) which is a significant financial element for hospitals. Until we get a handle on the cost of health care, health insurance rates will continue to rise and a viable single payer proposal, where you have more than one or two hospitals participating, will only be a dream.
The limitations to the BlueCard program for 2019 on PPO plans means the out-of-area health care services are no different than Blue Shield’s Trio HMO plan for individuals and families. Unless the health care services are for emergency or urgent care they won’t be covered unless the member has prior authorization from Blue Shield of California.
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.
Because of all of the numerous ways a provide network search can give incorrect results, I am now recommending that people print out a list of providers in their area. Usually the list can be created in a PDF format that is searchable with Adobe Acrobat Reader. You can look through the list of doctor names alphabetically. You might see Dr. Balabat and realize that is your doctor when you thought the name was spelled Baladat.
If you reside in any of the above counties you will be able to keep your EPO plan. If you reside in any other county, and you have an Anthem Blue Cross EPO or HMO plan, through Covered California or off-exchange, you will need to select a new insurance carrier for 2018. The exit of Blue Cross from the individual and family market does not affect employer group health insurance plans or their Medicare Advantage plans.
Members of Western Health Advantage (WHA) have been notified that beginning in 2018 they will no longer be able to have a UC Davis Medical Group doctor as their primary care physician. WHA has already started working with current members to transition to a new PCP with Mercy Medical Group, Hill Physicians, Woodland Clinic, or NorthBay Healthcare. However, if you don’t want to give up your UC Davis PCP and specialists, there are other health plans that UC Davis Medical Group will accept.
Before I start gathering coverage information, I create a table with preferred or “must have” providers, hospitals, and drugs in rows, with the available health plans across the top columns. I then mark which health plan has the providers in-network and if the drugs are covered and at which Tier.
But if you don’t have an account, are trying to help a family member or friend, or are just checking to see if you current mental health provider might be covered in a new health plan, you will have to swim in the sea of confusion for finding the doctor or counselor. Some of the health plans have great online directories and others really suck. Here is an overview of what I learned.
The California Department of Health Care released a report confirming that several health plans may have had inaccurate provider directories for their member to search through. The Timely Access Report year 2015 reviewed several different measurements to determine if health plan members could obtain timely access to health care services. The report noted that 13 health plans listed Primary Care Physicians who were not in the health plan’s provider network.
The one aspect of health insurance that the Affordable Care Act did not address is the cost of health care services. Without a governor on the prices that doctors and hospitals can charge, the health insurance companies must constantly increase their rates to cover the cost of health care expenses that seem to rise faster than the national average for inflation. One way to reign in the ever increasing costs of health care is by providing consumer information on the cost of health care services through price transparency. The Health Care Transparency Project has started an online petition to request the Trump administration implement price transparency for consumers.