Kevin Knauss: Health, History, Travel, Insurance
Posts related to health and life insurance in California, Covered California, rates, subsidies, short term medical and travel plans.
When searching for supplemental health benefits like dental and vision insurance, be cautious of paying additional fees or joining membership associations tied to the insurance. VSP vision insurance, Delta Dental and AARP all have marketing agreements that mandate the purchase of an association membership or one-time fee. These associations may offer little value to the member and only serve as another revenue stream for the issuing company.
California doctors, upon finding that the new Covered California health plans may not reimburse them enough to maintain their vaunted lifestyle, are kicking existing patients with the new health insurance out of their practices. These doctors are the epitome of the maxim “Putting profits before people.” Most of these greedy doctors haven’t exercised the common decency to notify their current patients before their appointments that unless they have the right color of health insurance, they won’t be served.
While the Insurance Gender Nondiscrimination Act (IGNA), also known as AB 1586, prohibits health plans from denying medically necessary health care to transgender individuals, the exact treatment options covered for individuals with gender dysphoria remain unclear in California. The determination of whether a health plan will cover a certain medical procedure to facilitate the transition to the opposite and identified sex of the health plan member hinges on the medical necessity of the procedure.
One of the strategies for enrolling hundreds of thousands of California residents in new Covered California health plans was to have an army of in-person Certified Enrollment Counselors. While these folks are trained on how to fill out the Covered California application, they don’t necessarily have any background in health insurance or how it works. Are the Certified Enrollment Counselors (CEC) qualified to answer simple to complex questions about health insurance and will they be there next month when their client has issue?
In an attempt to help consumers decide on the right health plan, Covered California has compiled a star rating system for the health insurance carriers based on outdated information. Even worse than basing a report on old data is the disastrous customer service that many Californians have experienced from many of these health insurance companies, including Covered California, in the last two months. The horrible customer service and nightmare enrollment process is not reflected in the new quality rating results.
When the insurance companies are having their risk for unexpectedly high health care expenses subsidized they should not have the luxury of creating tight doctor and hospital networks. The restrictions on network providers for cost containment purposes is exceptionally irritating when it is the plan members that are helping fund part of the risk reduction provisions by having to pay for the reinsurance fee on qualified health plans. Restricted networks and new EPOs are just a “work around” solution to allow health insurance companies to selectively limit health care like they have done in the past.
Families that didn’t have their insurance cancelled by the ill-fated Covered California forced policy cancellation of December 31 are now wrestling if they should make their current health plan premium for January. The utter lack of communication between Covered California and the health plans has left many families without knowing if they do or don’t have health insurance.
The Affordable Care Act is failing families on two major issues that need immediate resolution. The employer sponsored health insurance regulation has left many spouses without affordable coverage and household income limits are placing children in Medicaid programs. Together, these two ACA regulations are unfairly fracturing the health insurance coverage for many families and need immediate changes.
Applications submitted to Covered California in October and November are missing agent designations and have corrupted household information when received by one of the insurance companies. It is hard to know if these data corruptions are an aberration or if the problem may be more widespread in the Covered California system. The bottom line is that these individuals have received no billing information from the carrier and the agent is not the broker of record.
Insurance Commissioner Dave Jones continues to wage not only a regulatory turf battle with Covered California over the issue of policy cancellations, he is also waging a war of words. No sooner had the California Health Benefits Board voted to continue with the planned cancellation of health plans for December 31st, Commissioner Jones fired off a press release to announce how unhappy he was at the Board of Covered California.
