If you are going to be spending an extended period of time outside of your plan area, for work, vacation, or going to college, carefully review your plan’s Evidence of Coverage to make sure the BlueCard Program is part of the covered benefits. I was surprised to learn that both Blue Cross and Blue Shield HMO plans included the BlueCard Program for 2017.
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.
Forcing either the health plans or the providers to post a list of costs for routine services is a very low impact way of adding consumer information to the health care market. The government is not telling the providers what they should charge. The government is not telling the health insurance companies what they should pay the providers. A law mandating a simple fee schedule like Kaiser Permanente has published will create price transparency and allow consumers to compare valuable health care cost information across a variety of health plans and providers. This will ultimately slow down the rate increases as providers compete not only on patient satisfaction, but on price as well.
However, I still don’t understand why the costs for services for Southern California Kaiser members are so much lower than prices for Northern California members. Does Kaiser just have more members in Southern California to spread the fixed costs of supplying the services over? Kaiser charges 29% more for a colonoscopy in Northern California than Southern California. Are more people getting colonoscopies in Southern California so the volumes of patients help drive down the costs?
Secretary Price’s positions on health insurance and health care are indefensible. They are cruel. They will devastate the lives of many women and children. I can only hope that voters wake up and take note of how Price and his Republican colleagues are hell bent on denying health care services to their children and neighbors and vote these people out of office. Women in America are not safe as long as Secretary Price is in charge of HHS.
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.
Since the beginning of health care reform under President Obama there has been intense speculation about how the health insurance companies will react when setting rates for the various health plans they offer. Health insurance is not a commodity like wheat, oil, or pork bellies where the market place of buyers and sellers agree upon a price. While competition does impact the rates to a certain degree, health insurance prices are largely determined by the health care services to be covered, the cost of health care services, and the expected claims for those services within a geographical location where the plan is being offered.
Given the Republican philosophy that less government is better government, Covered California’s reason for existence may evaporate. But it all hinges on Trump’s term ‘transition’. Does he want to transition away from the Marketplace Exchanges, or is he merely suggesting transitioning away the Qualified Health Plans as a requirement for the tax credit?
Covered California has given their online health insurance enrollment system a serious make over with the release of the CalHEERS 17.2 build. Not only has the user interface been enhanced, members must now enter their employer’s contact information before they will be eligible for the monthly subsidy. In addition, Covered California will begin notifying a member’s employer when they enroll or renew their Covered California health insurance.
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.