Kevin Knauss: Health, History, Travel, Insurance
Posts specifically related to California health insurance, enrollment, premiums, plans, termination, Covered California, Medi-Cal, Medicare, small groups.
The first challenges individuals and families faced with the smaller provider networks offered in California was keeping their current physician or finding doctors that would accept the new health plans for health care treatment. The next hurdle has been doctors referring or using out of network physicians for patient care. Patients are now getting slapped […]
Solid information is hard to come by when it relates to what health insurance plans will cover for gender reassignment surgery in California. In response to the Insurance Gender Non-Discrimination Act passed by California in 2013, some health plans have created detailed medical policies for transgender health benefits. For a variety of reasons the health insurance companies don’t make their policies readily available to the general public. I was able to locate two detailed outlines issued by Blue Shield of California relating to gender reassignment surgery.
As the ACA open enrollment winds down, attention now turns to helping individuals and families in the new health plans actually get health care from their insurance. While there have been significant challenges just getting people signed up for health insurance, there will surely be additional hurdles as households now try to use the new health plans. For most people, they have no advocate to help them maneuver through the maze set up by health care professionals and insurance plans. Who will be the health insurance advocates for these families?
Covered California doesn’t have a monopoly on individual and family health plans in California. In addition to the carriers participating in the California exchange, Cigna is also offering health insurance outside of Covered California. Cigna is offering eleven different individual and family plan (IFP) options in California: seven Baseline Portfolio plans and four plans that mirror the Covered California standard metal tier levels for 2014. None of their plans are available through Covered California for the Advanced Premium Tax Credit.
With more working Americans eligible for expanded Medicaid health insurance there is also a growing fear that some government agency will want to seize a recipient’s assets to pay for the health care expenses. Fortunately, the expanded Medicaid, Medi-Cal in California, works under slightly different rules and provides some protection against “claw back” of assets to satisfy health care debt. However, one age group may be subject to Medi-Cal estate recovery rules under expanded Medicaid.
Health Net notified all their California agents by a letter dated January 29th, that effective March 1, 2014, they will slash the sales commission by over 50% on four of their five individual and family plans offered in California. This further reduction in compensation for agents since the ACA was passed continues to make customer service oriented health insurance agents a “family of dinosaurs” who will quickly become extinct.
When Covered California decided to force health insurance companies to cancel their policies on December 31, 2013, they set in motion a cascading effect that have left many new plan members without access to prescription drug coverage. At least two pharmacies have recognized the problem and are offering help to cover vital prescription medications to new Affordable Care Act health plan members that have yet to received neither member ID numbers nor an invoice.
A pregnant Bay Area woman who applied for health insurance through Covered California in November and has yet to receive any notification from her selected health plan or Covered California must now consider cancelling her prenatal doctor visits for lack of insurance. When asked about the status of the woman’s application a Covered California call center staffer said that it can take weeks for the insurance companies to receive the application. Essentially, Covered California has decided to ignore the woman, her family and unborn baby.
One of the biggest questions I get is, “When will Covered California send me a bill for the health insurance?” Unfortunately, Covered California doesn’t invoice for the health insurance, that is left up to the insurance companies. If your application has been successfully transmitted to the insurance company you can make your first premium payment over the phone. Some applications have not, and may never, actually make it to your selected insurance company.
Covered California had high expectations for 21st century e-commerce technology but agents and consumers have resort to 19th century pen and paper. There has been an avalanche of paper applications into Covered California significantly slowing down the verification and enrollment process. The sluggish processing of applications means that some families may not have insurance coverage on January 1, 2014 as promised.
