December 17, 2008
First 5 California Contribution Extends Health Coverage to More Than 65,000 Children
With the help of funding from First 5 California, the state's Healthy Families program today moved to safeguard more than 65,000 infants and children from waiting lists for health coverage due to the budget crisis.
First 5 California will provide $16.7 million to the Managed Risk Medical Insurance Board, the agency that administers Healthy Families. The funds will be used to pay health care premiums for children up to age 5 who are new applicants to Healthy Families through the end of the fiscal year in June.
"Today's action will allow the state to continue to enroll tens of thousands of infants and children in the Healthy Families program, ensuring them access to much-needed health care services," said Governor Arnold Schwarzenegger.
With their unanimous vote Monday, State Commissioners affirmed First 5 California's ongoing commitment to helping ensure all children have access to health coverage, particularly during this period of high unemployment and economic instability.
"First 5's action shows that anything is possible when all sides come together to tackle a problem -- even in the worst budget times," said Senate President Pro Tem Darrell Steinberg.
Assembly Speaker Karen Bass added, "I thank the First 5 commissioners, including my appointees to the panel, for hearing our appeals and stepping up to the plate with a responsible resolution for these children."
Since voters passed Proposition 10 in 1998, First 5 California has established itself as the largest and most stable funding source of health coverage for children up to age 5 in California. Last year, the agency spent more than $48 million on children's health insurance.
"First 5 California is proud to help take this first step forward in expanding children's health coverage as part of our larger mandate to serve the needs of our state's youngest children," said Kris Perry, First 5 California executive director.
Forty-seven county commissions are committed to presenting their commissioners with requests to help provide part of this funding in the coming weeks.
First 5 county commissions that have pledged support include: Alameda, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Kern, Lake, Lassen, Los Angeles, Madera, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Orange, Placer, Plumas, Riverside, Sacramento, San Benito, San Diego, San Francisco, San Joaquin, San Luis Obispo, Santa Clara, Santa Cruz, Shasta, Solano, Sonoma, Stanislaus, Tehama, Trinity, Tuolumne, Ventura, Yolo and Yuba.
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Posted by healthinsurance at 12:38 PM | Comments (0)
December 02, 2008
Anthem Blue Cross Gives the Gift of Health to California
This December, Anthem Blue Cross is giving the gift of health to California as the Anthem Blue Cross HealthFair Bus travels the state offering free health evaluations. Launching on Monday, December 1 from the Anthem offices in Woodland Hills, California, the bus will depart on a multi-city tour to include Los Angeles, Ventura, Oxnard, Ojai, Fresno, Sacramento and San Francisco.
"Onboard the Anthem Blue Cross HealthFair Bus visitors will receive, free-of-charge, a health evaluation consisting of a full lipid panel; weight, height and waist measurements; blood pressure test; and Body Mass Index analysis. Together, these tests provide a snapshot of one's personal health," explained Leslie A. Margolin, president of Anthem Blue Cross. "Anthem is committed to the community, offering this service regardless of employment, immigration or insurance status. By proactively empowering individuals with vital, personal, medical information, we are taking an important step toward keeping Californians healthy."
"We're particularly enthusiastic about this tour because we'll be reaching several populations that might not necessarily have access to basic primary healthcare," noted Margolin. "For example, in the greater Los Angeles area we are partnering with strong community organizations such as the Urban League, P.A.T.H. (People Assisting The Homeless) and the Kedren Community Mental Health Center -- offering the free health screenings to their constituents. Anthem is committed to improving the lives of the people we serve and the health of our communities."
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Posted by healthinsurance at 09:07 AM | Comments (0)
November 26, 2008
Health Insurers See ''Universal'' Opportunity
Health insurance companies such as Humana and UnitedHealth always seem to pay a price for "gifts" from the federal government.
Over the past several years, they have pocketed billions of dollars in government subsidies selling private Medicare plans. They know that Democrats aim to cut those bonus payments, however, so they're searching for new ways to grow. They see universal health care, which could turn 46 million uninsured Americans into potential customers, as their next big opportunity.
President-elect Barack Obama has regularly listed universal health care among his top priorities. Even so, some experts believe, the new president must address his prime concern -- the economic crisis -- before he can think about launching an expensive health care program. As a result, they say, private insurers will likely endure the looming Medicare cuts with little opportunity to offset those losses.
"There isn't going to be a growth driver in the health insurance business for the next few years," predicts Robert Laszewski, an industry consultant who serves as president of Health Policy and Strategy Associates. "It's going to be very bad times relative to the very good times" health insurance companies have enjoyed.
Others still see a real chance for meaningful reform. They believe that the economic crisis has been caused in part by skyrocketing health care costs, which have been blamed for half of all personal bankruptcies and the decline of giant corporations such as General Motors and Ford . As a result, they feel that the country's leaders must address both issues at the same time.
Sheryl Skolnick, senior vice president of CRT Capital Group, belongs to that camp. The veteran health care analyst predicts that Democrats will pounce on the "irresistible opportunity" to pass a comprehensive health insurance bill now that they have the power to do so.
Californians, click here for your free health care quote now!
Posted by healthinsurance at 10:38 AM | Comments (0)
November 24, 2008
California health insurance premiums rising more slowly
Thousands of Sonoma County workers are facing decisions about their California health insurance, with many employer-sponsored insurance plans entering their annual open enrollment period.
Premiums continue to march upward but by and large seem to be in line with a trend seen last year: rising, but at slower rates than in the first half of the decade, when they rocketed higher and buffeted the local health care market.
Health insurance brokers who negotiate health plan packages for local companies say they are seeing some premium increases below 10 percent this year -- although depending on the plan and company size, some increases are far higher.
"It's all over the board," said Bud Martin of ABD Wells Fargo Insurance Services in Santa Rosa.
"It depends a lot on the size of the group and what kind of benefit structures they have," he said. "Sometimes it's 10 or 11 percent, sometimes it's 17."
Nationally, the annual cost of family coverage under employer-sponsored plans reached an average of $12,680 in 2008, up from $5,791 in 1999, according to the Kaiser Family Foundation, a nonprofit health research group. Employees' share of that annual bill hit an average of $3,354 last year, up from $1,543 in 1999.
Experts caution that workers shouldn't choose a plan on premiums alone, but should take into account factors such as how much they expect to use health care services.
"Often employees will just choose the plan that sounds the best or the name that sounds the best," said Debra Squyres, director of human capital consulting at TriNet. For example, an employee might choose a "Platinum" plan over a "Value" plan "not knowing really how that plan works," she said.
The San Leandro-based firm provides human resource outsourcing services including benefits management to about 900 Northern California firms.
Some plans, said Squyres, are not raising their premiums as much, but are offsetting that by increasing their patient deductibles, co-payments and out-of-pocket maximums.
That's not necessarily bad, because people who use their health services less may find that option more sensible and cheaper. But it illustrates why plans need to be carefully examined, Squyres said.
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Posted by healthinsurance at 11:56 AM | Comments (0)
November 19, 2008
Children from California Could Lack of Low-Cost Health Insurance
State officials from California want to cap the list of people registered in the health insurance system based on children of the poor working people. The authorities stated that this decision can come because of too many new clients who take upon the insurance health system.
But advocates say that if the Healthy Families Program needs such a drastic change, this would be the hardest decision to be taken in a 10-year history time. Lesley Cummings, the executive director of the Managed Risk Medical Insurance Board, said that nearly 162,750 children would have to wait almost six months before being checked by a doctor.
The program now gives medical insurance for almost 900,000 children and an averaged 27,000 kids are subscribed every month. If no action is taken, the system will reach a $17.2 million loss. A decision is expected to be taken in December and the waiting list will also be settled on December 18.
Cummings stated that if the board doesn’t cut the enrollment now, worse actions will be necessary taken later. "Capping enrollment, rather than eliminating coverage that a child currently has, seems the preferable path," he added. The bad thing is that kids who come from families who earn up to %250 of the federal poverty level are eligible for this health program.
Incomes of $3,667 a month divided to a family of three are $4,417 a month divided to a family of four makes it possible for the parents to subscribe their children to the Healthy Families Program. Those who are below this line get healthcare through Medi-Cal program.
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Posted by healthinsurance at 12:23 PM | Comments (0)
October 30, 2008
California Health & Longevity Institute Offers Innovative Health and Wellness Strategies
For organizations seeking innovative health and wellness solutions to offer employees during Open Enrollment season, California Health & Longevity Institute provides evidence-based programs to instill a culture of health throughout a corporation. The implementation of long-lasting wellness initiatives achieves an overall healthier workforce, higher productivity levels, increased employee retention and reduced health insurance costs. According to noted corporate health expert Steven Aldana, Ph.D., more than 30 published articles cite evidence that $3.50 are saved from lower healthcare costs per every dollar spent on employee health and wellness programs.
Programs and services at California Health & Longevity Institute are based upon the foundation of health and wellness: nutrition, fitness, medical and strategies for change. Leading experts including physicians, registered dietitians, exercise physiologists and lifestyle consultants offer immersive, customized group programs as well as individual consultations. A state-of-the-art medical clinic offers executive physicals, complementary medicine therapies such as acupuncture and diagnostic testing.
Companies are investing in longer-term solutions aimed at improving overall quality of life for employees and health of their organizations as the cost of employer-sponsored benefits continue to eclipse the majority of expenditures. Studies also note that more than 75 percent of employers' health-care costs in California and productivity losses are related to employee lifestyle choices (Centers for Disease Control and Prevention). Approximately $260 billion in output is lost each year due to health-related problems. (The Common Wealth Fund).
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Posted by healthinsurance at 10:50 AM | Comments (0)
October 08, 2008
Schwarzenegger vetoes health insurance bill
Gov. Arnold Schwarzenegger vetoed a bill Tuesday that would have cracked down on health insurance companies that cancel policies of people who make expensive claims.
Schwarzenegger, in a memo to lawmakers, called the so-called rescission practice “deplorable,” but noted he vetoed the bill because it lacked several consumer protections and was “written by the attorneys that stand to benefit from its provisions.”
The measure would have established an independent review process of each case and required that policies be rescinded only if insurers prove consumers willfully misrepresented their pre-existing conditions on a policy application.
Schwarzenegger said he wanted the bill to include six other protections, including a requirement that companies continue health insurance coverage for family members of someone whose policy has been dropped.
Assemblyman Hector De La Torre, D-South Gate, who sponsored the health care bill, said the governor's criticisms were ill-founded. He said the family protection provision was left off the bill because it was contained in a different measure that the governor approved, Assembly Bill 2569.
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Posted by healthinsurance at 03:29 PM | Comments (0)
October 05, 2008
Schwarzenegger Vetoes Health Insurance Bill
Gov. Arnold Schwarzenegger vetoed a bill Tuesday that would have cracked down on health insurance companies that cancel policies of people who make expensive claims.
Schwarzenegger, in a memo to lawmakers, called the so-called rescission practice “deplorable,” but noted he vetoed the bill because it lacked several consumer protections and was “written by the attorneys that stand to benefit from its provisions.”
The measure would have established an independent review process of each case and required that policies be rescinded only if insurers prove consumers willfully misrepresented their pre-existing conditions on a policy application.
Schwarzenegger said he wanted the bill to include six other protections, including a requirement that companies continue California health insurance coverage for family members of someone whose policy has been dropped.
Assemblyman Hector De La Torre, D-South Gate, who sponsored the bill, said the governor's criticisms were ill-founded. He said the family protection provision was left off the bill because it was contained in a different measure that the governor approved, Assembly Bill 2569.
“The governor is not fulfilling his obligation to the insured population of California,” De La Torre said. “For the foreseeable future they will be able to be dumped with impunity, as they have in the past.”
De La Torre also noted that the governor had stonewalled legislators in negotiations.
“It's good enough for him to get an applause line in the State of the State address, but it's not good enough for him to follow through and work with Legislature to make it happen,” he said.
Daniel Zingale, the governor's top health adviser, said Schwarzenegger's opposition to rescission is clear, noting that the state has taken several actions against California health insurance companies during his administration.
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Posted by healthinsurance at 03:29 PM | Comments (0)
September 16, 2008
Health Net To Reinstate Canceled Health Insurance Policies In California, Pay Fine, Reimburse Former Plan Members For Denied Claims
Health Net on Thursday agreed to reinstate coverage for 926 former members in California whose health insurance policies were canceled after they filed claims and to pay $3.6 million in fines, the Los Angeles Times reports. The company also will pay as much as about $14 million to reimburse expenses for medically necessary care that would have been covered had the policies not been cancelled.
In the last year, Health Net -- California's largest health insurer -- has been forced to pay a number of fines and penalties related to the company's policy rescission and cancellation practices, according to the Times. An investigation by the California Department of Insurance found that the company did not follow state laws whKen handling policyholders' claims and treated them unfairly. Health Net also will work with the department to make improvements to its cancellation and rescission practices and could face an additional penalty of as much as $3.6 million if a follow-up investigation finds that the company has not corrected all deficiencies, the Times reports.
The agreement allows Health Net to avoid any further penalties for potential legal violations uncovered by auditors. The California health insurance company did not admit any wrongdoing. Chief Executive Jay Gellert said his company did "not necessarily agree with the California Department of Insurance," but the settlement was a chance "to move forward and make sure these affected individuals can obtain coverage" (Girion/Lifsher, Los Angeles Times, 9/12).
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Posted by healthinsurance at 07:24 PM | Comments (0)
September 04, 2008
Thousands of California children in danger of losing health insurance
Thousands of Californian children are in danger of losing health insurance, indicating the failure of the state's promising strides toward extending medical coverage to all its children, the Los Angeles Times reported on Sunday.
Increased premiums for low-income families are expected to put the program out of reach for many and a new insurance policy in California is also expected to cut enrollees, the paper said.
"The trend is likely to further destabilize California's already shaky healthcare system," the paper noted.
Studies have found that children without health insurance are less likely to go to the doctor for routine visits that allow early diagnoses and treatment for diabetes, obesity and other increasingly common ailments, according to the paper.
Between 2001 and 2005, the number of Californians younger than 19 who were uninsured at any given time decreased 25 percent to about 763,000, according to the for Health Policy Research at the University of California in Los Angeles.
Uninsured children in California tend to perform worse in school and miss more classes than those with coverage, several studies have found.
Most of the drop came through aggressive enrollment efforts in state and private healthcare programs and despite the erosion of employer-based insurance, which was leaving more adults without coverage, the paper said.
But legislative budget negotiators this year have decided to increase premiums for the state's California's Healthy Families program, which pays for medical care for more than 850,000 children of low-income workers who are above the federal poverty line.
The state estimates that the parents of 19,000 children will end up dropping out of the program by July because of the two-dollar or three-dollar monthly increases. A family with three or more children, earning between two and 2 1/2 times the federal poverty level of 24,800 dollars a year, would see the monthly premium rise to 51 dollars.
The state expects the rule to pare Medi-Cal rolls by about 196,000 children over the next two years.
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Posted by healthinsurance at 07:50 PM | Comments (0)
August 13, 2008
Thousands of Californians whose health policies were canceled to be offered new coverage
About 3,400 Californians whose health insurance was canceled by Kaiser, Health Net, and PacifiCare after they got sick will soon receive notification that they may be eligible for new coverage and for compensation for medical bills they paid while they were uninsured.
In a deal with state regulators, the insurers agreed to offer former members new coverage regardless of preexisting medical conditions and to reimburse them for medical expenses. In exchange, the California Department of Managed Health Care will close investigations into the companies' rescission practices. Regulators began mailing out notices to individuals Tuesday.
The state's largest insurers have all been widely accused of looking for ways to drop individual policyholders who incur high costs. The insurers contend that members who are dropped have misrepresented their medical histories on their applications.
The practice has been condemned by lawmakers, judges and regulators.
The agreements between the state and the insurers were unprecedented in their ambition to restore health insurance coverage. But they also have come under fire from consumer advocates.
The mailed notices triggered another flare-up.
Lawyers for policyholders expressed concern Friday at a hearing in a suit against Health Net over a plan for the insurer to notify former members about the state agreement.
State law stipulates that such notices go through lawyers for members of the presumed class, said Mike Bidart, one of the policyholder lawyers.
What's more, he said, California insurance policyholders would eventually receive court-approved notices about developments in the case, including any settlement.
"Our concern was that it creates tremendous confusion for people to get one notice and then another," he said.
Los Angeles County Superior Court Judge Victoria Chaney set a hearing for Sept. 2 to consider the issue. Then late Monday, Bidart said he learned that the state intended to send the notices out itself.
"I'm sure they are doing this because the courts don't currently have jurisdiction over the DMHC," Bidart said. "They are basically end-running what was about to be heard by the court."
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Posted by healthinsurance at 01:20 AM | Comments (0)
August 05, 2008
California insurance bill nears completion
The state of California is nearing a compromise on legislation that would tighten controls on individual medical insurance policies, sources said.
The bill aims to restrict profit on individual policies, mandate a minimum for benefits and regulate California insurance companies' ability to cancel plans retroactively, the Los Angeles Times reported Monday.
The plan falls short of Gov. Arnold Schwarzenegger's original plan of providing insurance for 5 million uninsured Californians, the Times reported.
State law makers rejected Schwarzenegger's $14.9 billion insurance plan in January, although insurance companies backed the bill, as it would have provided them with millions of new customers, the report said.
The new bill has little support from California health insurers because it crimps profits on some of their most lucrative policies, the Times reported.
A 2006 survey found that individual policies cost an average $259 per month, compared with $383 per month for policies purchased by small businesses for their employees.
Individual policy owners, however, paid three times the amount the group policy members paid for deductibles and co-payments, the Times reported.
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Posted by healthinsurance at 12:01 PM | Comments (0)
July 30, 2008
Federal Standards For Long-Term Care Insurance Policies Needed, Witnesses At House Hearing Say
Witnesses on Thursday at a House Energy and Commerce Oversight and Investigations Subcommittee hearing called on federal lawmakers to require minimum standards for private long-term care insurance policies, CQ HealthBeat reports. Bonnie Burns, a training and policy specialist at California Health Advocates, said that, because states regulate such policies, the standards offered differ based on where policyholders live. She said, "It should not depend on the state a person lives in whether they have a quality product," adding, "There's a disconnect between those services available in a community and the way they are described in a California insurance policy, and no two companies have the same definitions."
Some witnesses also raised concerns about large premium increases for long-term care insurance policies. Washington State Insurance Commissioner Mike Kreidler in written testimony said, "The majority of consumer complaints my office receives about long-term care insurance are about the double-digit rate increase they received on products they purchased in the late '80s and early to mid '90s."
In addition, witnesses discussed the inconsistencies in denials of claims submitted under long-term care insurance policies. Burns said that such denials often appear "completely unpredictable." However, according to Marc Cohen, president of the long-term care research and consulting firm Life Plans, a recent survey conducted by the company found that, among 1,500 policyholders who filed claims under long-term care insurance policies, 94% reported no unresolved disagreements with their California health insurers and that insurers denied only 4% of those claims.
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Posted by healthinsurance at 08:43 PM | Comments (0)
July 18, 2008
Rising Costs and Universal Health Care in California
As you know, since most of you are co-authors of this bill, SB 840 is California’s plan to establish a functional, modern, universal health care system for the 21st Century.
This bill covers every California resident with comprehensive, affordable health benefits, contains the growth in health care spending while improving quality.
And most importantly it guarantees every patient with total choice of their doctors and hospitals.
Each year health care costs grow 2-3 times faster than wages. The Journal of Health Affairs recently reported that health care spending will nearly double over the next decade. This means that, in 10 years, healthcare will cost 20 cents of every dollar our nation produces.
With that kind of cost inflation, discussions about covering the uninsured are pointless. Our failure to address this problem is close to gross negligence.
In the real world, 50% of bankruptcies are due to medical costs, employers are eliminating benefits if they can, and if not, like so many school districts and other public employers, they may face bankruptcy.
Our own budget crisis is greatly affected by the rising health care costs. The state budget buys a lot of healthcare in Calfifornia - directly through public programs and as employers.
If costs grow 2 to 3 times faster than wages, but the taxes that pay for the health care are a function of wages, then we are basically stuck in quicksand - each year sinking deeper and deeper.
In response to exploding health care costs, we are dismantling our system. Not one of us in this room has the level of health care benefits we had 10 years ago – and we’re paying a lot more for what we still have.
The US is now in a state of severe health care rationing. Doctors’ reimbursements are frozen. Coverage for the insured is very fragile and unreliable due to rescission, improper denials, gutted benefits, and growing deductibles. Patients experience shockingly long wait times, shorter hospital stays, fewer specialist visits, limited drug formularies, and rushed doctor visits. And yet…costs keep rising.
In 2005, the Lewin Group completed a financial analysis of the bill which found that the bill would be fully funded in 2006 with a combined payroll tax of about 12%. The report additionally found that the bill would produce savings of about $29 billion in the first year alone, most of which will be spent on insuring the uninsured and improving the health care benefits for all of us.
The Lewin study found that SB 840 would save California businesses 16% off their employee benefit costs, while families would save hundreds of dollars a year and state and local government would save nearly $1 billion in the first year alone.
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Posted by healthinsurance at 06:06 PM | Comments (0)
July 09, 2008
Kids health insurance program in California to close
he countdown has begun for families served by the Alameda Alliance for Health's Healthy Kids program.
Phone calls and letters continue to roll out to families this week after the Alliance's June 30 announcement that it expects close the Healthy Kids program on Sept. 30 because of a lack of funding and diminished hope for the creation of a state universal health care plan for children.
"We had thought it was going to be a two-to-three-year effort to make the policy (changes) happen," said Alliance Chief Executive Officer Ingrid Lamirault, referring to policy that would provide universal health care coverage for all California children, regardless of their immigration status.
But the story of Healthy Kids has reached its final page without the happy ending for which administrators were hoping.
Proposed state legislation, which would have provided more coverage for children, stalled in January in the face of California's budget crisis. With the stall, the final phase of Healthy Kids in Alameda County began.
Started in 2005, the program provides low-cost, comprehensive coverage for 1,050 children in low-income families not eligible for government-funded programs like Medi-Cal. There are Healthy Kids programs in 30 counties statewide serving more than 80,000 children.
The program's closure could leave those children without any insurance options and further strain county clinics and emergency rooms which likely will become the primary care centers for the uninsured.
About 95 percent of the children in the Alameda County program are undocumented immigrants.
The program, like in other counties, had been funded by public and private grants, but six months ago, "things started unraveling," said Lamirault.
Earlier this year, two separate health care reform bills sponsored by state Senate President Pro Tem Don Perata, D-Oakland, and former Assembly Speaker Fabian Nunez, D-Los Angeles, were held up in committee.
With hopes of universal health care legislation dashed at least for now, the program later learned it would lose more than half of its funding this year and the remainder over the next year and a half.
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Posted by healthinsurance at 10:38 PM | Comments (0)
July 06, 2008
Health Net of California Signs Agreement with Alvarado Hospital
Alvarado Hospital of San Diego and Health Net of California, Inc. have signed a new agreement that provides California Health Net members with access to health care at Alvarado Hospital.
The contract covers Health Net members with employer-sponsored, Individual & Family Plans, Medicare, Medi-Cal and Healthy Families coverage. Members have access to Alvarado's wide range of medical services, including medical and nursing care, inpatient and outpatient surgeries, many specialty services such as bariatrics and skull base surgery, and complete orthopedics, emergency room care and diagnostic testing.
"Our agreement means San Diegans covered by Health Net health insurance may continue receiving the same quality care they have come to know and trust from Alvarado Hospital," said Martha Smith, Health Net's vice president of Health Plan Network Management.
"We have long-established relationships with Health Net members, and we have excellent physicians on our medical care staff who have provided care to Health Net members for years," said Harris Koenig, Alvarado Hospital chief executive officer. "We are excited to have the opportunity through this new agreement to continue caring for them."
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Posted by healthinsurance at 04:21 PM | Comments (0)
July 01, 2008
California Health Insurance Companies Spend $10.3 Billion On Administration And Profit
Private health insurance companies regulated by the Department of Managed Health Care (DMHC) spend $6 billion each year on administration, and divert an additional $4.3 billion to profit, according to a report released by the California Medical Association (CMA). Prepared using data obtained under the Knox Keene Act, the report breaks down how private health insurance companies spend their revenues.
"This report paints in stark terms why health care costs are skyrocketing for Californians," said Dr. Richard Frankenstein, M.D., President of CMA. "Health insurance companies in California spend billions of California's health care dollars each year on administration, and for-profit insurers divert billions of dollars more to profit. Californians' health care dollars should be spent on health care, not on bureaucracy."
Currently, private health insurance companies regulated under Knox Keene - representing some 60% of the health insurance market - are required to spend no more than 15% of their revenues on administrative costs. CMA and other health care advocates believe the statute includes profits as administrative costs; health insurance companies exclude profits from the 15%, allowing them to spend as little as they want on actual California health care. SB 1440, a bill authored by Senator Sheila Kuehl and sponsored by CMA, would require insurance companies to spend 85% of their revenues on health care, driving down health care costs for consumers and potentially making coverage more affordable.
"It's not acceptable for us to ignore such massive waste in the California health insurance industry when Californians are being bankrupted by rising health insurance premiums and gutted benefits," stated Senator Kuehl. "California consumers have a right to know that there is a basic formula in the law for how much of their money is actually being spent on medical care. This is the least we should be doing."
If SB 1440 had been in effect in the last reporting year, HMOs would have spent $1.1 billion less on administrative costs and profit - money that would have gone instead to provide health care to their policyholders. Blue Cross policyholders alone would have benefitted from $700 million more in health care that instead went to administrative costs and profit.
The Department of Insurance (DOI) collects the same data as the DMHC, but the DOI refuses to make the data public. CMA strongly supports the DOI and DMHC releasing this information to the public so that consumers can make informed decisions about whether a health plan is spending their premiums on health care.
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Posted by healthinsurance at 01:16 PM | Comments (0)
June 26, 2008
Opposition to Proposed Health Care Cuts Rises in California
Gov. Arnold Schwarzenegger's (R) proposed budget changes to health care programs would increase the number of uninsured residents in California by about one million over the next three years, according to a study released Wednesday by Health Access California, a consumer advocacy group, the Los Angeles Times reports.
The report said the governor's proposed 10% cut to Medi-Cal payments to health care providers and changes to Medi-Cal eligibility rules would create much larger increases in uninsured residents than previous studies have estimated. Medi-Cal is California's Medicaid program (Rau, Los Angeles Times, 6/26).
The report projects that:
* 471,500 children would lose Medi-Cal coverage over the next three years because of Schwarzenegger's proposal to require eligibility verifications quarterly rather than yearly (Rojas, Sacramento Bee, 6/26); an
* 429,000 adults would lose Medi-Cal coverage if the maximum income eligibility level for the program is dropped to 61% of the federal poverty level.
In addition, the California Budget Project estimates that 60,000 children would lose coverage through Healthy Families, California's version of the State Children's Health Insurance Program, if premiums are increased. The governor has proposed increasing monthly premiums by:
* 77% for children from households with incomes between 151% and 200% of the poverty level; and
* 27% for children from households with incomes between 201% and 250% of the poverty level.
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Posted by healthinsurance at 03:32 PM | Comments (0)
June 22, 2008
Huge demonstration for better health coverage in California
Government officials joined thousands of patients, union members and activists from throughout Northern California in front of San Francisco's Moscone Center Thursday afternoon to advocate universal health care and protest insurance-company practices.
Protesters — including an unknown number from the Palo Alto/Stanford area — lined Fourth Street and wrapped around Howard Street, swarming the building where California insurance companies and stakeholders were gathering for an annual convention.
America's Health Insurance Plan, an association representing some 1,300 companies that provide health insurance, hosted Thursday's conference, called Institute 2008.
Outside the conference, advocates held signs with slogans such as "Patients Not Profits" and chanted expressions such as "Californians should beware, insurance companies just don't care."
Speakers included state Sen. Sheila Kuehl, D-Los Angeles, San Francisco Supervisor Tom Ammiano and Los Angeles City Attorney Rocky Delgadillo.
"All of us know the California health care system should be a model for the country," Delgadillo said.
He said the nation's health care system is "broken" and some insurance companies maximize profits at the expense of patients and illegally rescind coverage when a person needs it the most.
Protesters focused on advocating two pieces of legislation. Kuehl's SB 840 would create a single-payer system for California and HR 676, introduced by U.S. Rep. John Conyers, D-Mich., strives to create a national single-payer health insurance program that would be publicly financed and privately delivered.
Donna Cook, a 60-year-old retired teacher, came in from Chico to attend today's event in support of single-payer health insurance.
She said that she has health insurance but that her daughter and 5-year-old grandson do not.
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Posted by healthinsurance at 04:22 PM | Comments (0)
June 16, 2008
United Health Group and PacifiCare announce $6.2 million grants
United Health Group Inc. and Pacificare announced Monday some $6.2 million in grants to a dozen California nonprofits that deliver California health care.
The grants are part of a state-required program to distribute a total $50 million in contributions and make some $200 million in investments over five years to benefit California health care.
United Health Group (NYSE: UNH) agreed to the payments as part of a deal negotiated by former Insurance Commissioner John Garamendi to ensure California consumers wouldn't be saddled with costs of the $9 billion takeover of PacifiCare by United Health Group.
The Northern California recipients of the grants include:
- $250,000 to San Francisco-based North East Medical Services to implement a chronic disease management system.
- $396,057 to Santa Clara-based Community Health Partnership to implement a clinical information management system.
- $276,859 to Stockton-based Child Abuse Prevention Council of San Joaquin County for start up costs for its Therapeutic Services for Children and Families Program.
- $394,470 to Sacramento-based La Cooperativa Campesina de California, to expand patient and physician use of a personal health record system designed for low-income populations with sporadic access to care.
- $841,140 to Fresno-based Kings View Behavioral Health System to implement a telemedical delivery system for mental health services.
- $2.5 million to the Sacramento-based Health Professions Education Foundation to expand its clinician support program that helps place clinical professionals in under-served communities.
- $100,000 for Salinas-based Center for Community Advocacy to help launch its Gang Violence Prevention Initiative.
- $326,357 to Quincy-based Plumas District Hospital to upgrade its telemedical capabilities.
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Posted by healthinsurance at 09:33 PM | Comments (0)
June 13, 2008
States Can't Stop Health Insurance Abuses
People who buy individual health coverage in most states are vulnerable to insurance company tactics that can deny them care, a health care advocacy group warns.
A survey of insurance commissioners across the country shows that all but five states allow insurance companies (including California) to deny coverage to sick or older patients. All but 15 states have no limits on how much companies can raise premiums if individual policy holders get sick, according to the consumer group Families USA.
About 14.5 million Americans bought their own insurance on the individual market in 2006, according to the Henry J. Kaiser Family Foundation. Those numbers would likely grow under the health reform plan being touted by Sen. John McCain, R-Ariz., the presumptive Republican presidential nominee.
McCain's plan would replace existing tax breaks for employer-sponsored coverage with tax credits individuals could use to buy coverage on the individual market. The change would likely shift millions of workers onto individual coverage, where they would be vulnerable to insurance companies' cost-saving tactics, says Ron Pollack, Families USA's executive director.
"To deregulate the market would make a bad situation even worse," Pollack tells WebMD.
The group's report found wide variation in the number of consumer insurance protections in states.
Some states -- such as Maryland, Illinois, and Idaho -- let patients appeal when their individual insurance coverage is revoked; other states -- such as Ohio, Kansas, and Arizona -- don't allow appeals. Most states guarantee that customers can review when companies deny individual claims. But in only a handful of states are those reviews free and conducted by an independent third party, the report says.
Overall, New York, Connecticut, New Hampshire, and California had among the most protections. States including Alaska, Arkansas, and Wisconsin had relatively few, according to the report.
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Posted by healthinsurance at 07:11 PM | Comments (0)
June 11, 2008
HMO Regulator''s Promise To Reinstate Health Coverage For Wrongfully Canceled Patients
HMO regulator's promise to reinstate California health coverage for wrongfully canceled patients; cautions that all health costs during gap must be covered.
Consumer Watchdog said such a step was largely unnecessary because the department's own surveys found a systemic failure at Blue Cross and other companies to review a patient's medical records and/or ask questions about past health conditions a process called "medical underwriting" - before issuing individual policy coverage.
Consumer Watchdog praised a California state regulator's efforts to begin reinstating the insurance coverage of patients left uninsured, uninsurable and often hundreds of thousands of dollars in medical debt when their health insurance policies were illegally canceled after they got sick. The nonprofit consumer group also cautioned that reinstatements must be complete and retroactive, with no gap in coverage from when the policy was issued to the time it was restored.
Last Monday, Consumer Watchdog petitioned the state Department of Managed Health Care to announce its plans regarding reinstatement of thousands of patients affected by the illegal practice.
"This a landmark step on the road to justice for the thousands of innocent patients those health insurance was retroactively canceled. This announcement applies to only 26 people, but the same law used here will provide reinstatement for thousands more. We look forward to working with the department," said Jerry Flanagan, Health Care Policy Director for Consumer Watchdog. "However, we caution that reinstatement must be retroactive to the time of the policy cancellation, and health insurers in California must be liable for all health expenses from the date of issuing the contract through the date of reinstatement. We're also very concerned about the state's plan to subject the remaining thousands of cases to unnecessary and lengthy 'third-party reviews' before restoring their coverage."
A recent survey of Blue Cross of California by the Department of Managed Health Care found that in 90 out of 90 retroactive policy cancellations - - known as "rescissions" - that it examined, Blue Cross failed to show that a patient "willfully misrepresented" a known health condition when applying for coverage. Such "willful misrepresentation" is the only legal grounds for rescission.
In a number of cases made public, policies were canceled for issues not related to the illness at hand, for instance the patient's stated weight on the application, or for omissions or errors that may have been induced by deliberately over-complicated application forms, or for medical issues in the applicant's medical record that the applicant was not aware of or did not understand.
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Posted by healthinsurance at 09:07 PM | Comments (0)
June 05, 2008
Kaiser Permanente Extends California Group Enrollment Deadline
Kaiser Permanente Extends California Group Enrollment Deadline
Deadline extended to Friday, June 6 for new groups to lock in current rates for one year.
Kaiser Permanente California has extended the small group enrollment deadline to this Friday, June 6. Small businesses that apply by Friday can lock in the current rates for one year. After June 6, rates will be increasing on average between 8% and 12%. Some Kaiser medical insurance plans will experience an increase in health insurance premiums as much as 17%.
The plan being hit the hardest by rate increases is the $0/$1500 Deductible Plan with HSA. Kaiser Permanente priced this plan very competitively in 2007 in order to gain market share on the new health savings account plans. Utilization on this plan was higher than expected and forced Kaiser Permanente to implement rate increases around 17% for new groups who begin coverage on July 1, 2008.
For these reasons, many groups are scurrying to get California group health insurance quotes and lock in coverage before the rates go up. Kaiser Permanente underwriters and staff, facing this influx of business and wanting to give groups enough time to submit enrollment forms, made the decision this week to extend the small group enrollment deadline five days beyond the normal June 1st deadline.
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Posted by healthinsurance at 09:12 AM | Comments (0)
June 03, 2008
California legislators revive plans to expand healthcare insurance
The California Legislature is moving to curb some of the health insurance industry's most profitable and contested practices as lawmakers resurrect portions of Gov. Arnold Schwarzenegger's unsuccessful proposal to expand medical coverage.
More than a dozen health bills are advancing through the Legislature, many over the objection of insurers. Some of the proposals were transplanted from the plan that passed the Assembly last year, only to be rejected in the state Senate in January. Other measures are newly devised by the Democrats who control the Legislature.
The bills would require insurers to spend at least 85% of their earnings on patient care; block insurers from canceling policies of patients who need extensive care; and force them to cover more procedures, such as maternity services.
Over the objections of the major doctor and hospital lobbies, the Assembly approved a measure backed by Schwarzenegger that would require medical providers to publicly reveal their costs and medical performance.
In a sign that a desire for piecemeal health care changes is strong this election year, some of the Democrats' bills even have picked up votes among Republicans who did not support Schwarzenegger's package.
"In the aggregate, it could be pretty significant," said Sheila Kuehl (D-Santa Monica), chairwoman of the Senate Health Committee, of the legislation. "I think it's just getting to the point where the opposition has just overreached so badly and the insurance companies' actions have been so egregious that both sides of the aisle are getting fed up with them."
The governor's health care proposal was rejected in large part because of its $14.9-billion price tag, which senators considered untenable with the state deep in the red. But the bills that are winning initial approval now put most of their costs on the healthcare industry.
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Posted by healthinsurance at 09:30 PM | Comments (0)
June 01, 2008
States target companies for rescinding health policies
An insurance-industry practice of retroactively dismissing individual health policies and leaving some people with costly medical bills has come under fire from California to Connecticut.
The practice is generating many complaints to government regulators and some lawsuits claiming insurers have improperly dropped coverage. Some states are passing tough measures or pursuing regulatory actions and assessing fines to restrict these retroactive health policy voids.
Insurance companies say such cancellations, which they call "rescissions," are a rare but necessary tool to stop consumer fraud and lower costs for all individual policyholders.
Yet, consumers and lawyers who have challenged such insurance cancellations say there are many examples of insurers targeting patients who have been diagnosed with chronic or life-threatening diseases that require costly medical care.
In Arizona, two women say in separate lawsuits that Health Net of Arizona dropped their policies after they were diagnosed with cancer and that the insurer demanded that their doctors, labs and other medical care providers refund payments. A Phoenix man sued Golden Rule Insurance Co. after his policy was dropped and the insurer refused to cover the costs to remove a brain tumor and other medical procedures.
"The goal is to try to put a stop to this practice because it is hurting a lot of people," said William Shernoff, a Claremont, Calif., attorney who has filed dozens of lawsuits challenging such policy cancellations by insurers. "It is not only a financial burden on the people. When their coverage is pulled, they can't get treatment."
New Mexico Gov. Bill Richardson recently signed a bill that limits insurance companies' ability to rescind a policy. Insurers must show a consumer has been "willfully fraudulent" before rescinding a policy. Before the change, insurers could merely point to a mistake or omission on a health insurance application before dropping a policy.
The insurance industry recognizes how such cancellations are seen as controversial, and has recommended changes that it says will be fair for consumers and insurers alike.
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Posted by healthinsurance at 07:18 PM | Comments (0)
May 29, 2008
Health Insurance Company Paid its Workers Bonuses to Cancel Patient Policies
Health insurance company Health Net Inc. rewarded employees for finding ways to drop customer policies and not pay for their medical expenses, according to an investigation by the California Department of Managed Health Care (DMHC).
Since 2005, the DMHC has been investigating five of the seven insurance companies that provide health care plans to individuals in California. The department is attempting to crack down on the practice among insurers of dropping people's coverage based on often accidental errors in their enrollment applications. In many cases, people's policies have been dropped after they submitted medical claims.
The DMHC has fined Health Net $1 million for failure to disclose a program in which employees received bonuses for meeting or exceeding quotas for health insurance policies to be dropped. The department continues to investigate Health Net and has yet to determine if the dropping of policies or the bonus program are illegal.
The DMHC describes itself as the only stand-alone watchdog agency for managed health care in the country. Since 2005, it has fined Blue Cross $1 million for rescinding its members' health plans and $200,000 for rescinding one person's plan in particular. It has also fined Kaiser Permanente's Kaiser Foundation Health Plans $325,000 for illegally rescinding two policies.
"None of the plans that we are investigating thus far have had an adequately fair process" for dropping policies based on application errors, said DMHC Director Cindy Ehnes.
Health Net's employee bonus program was revealed in the course of a lawsuit by a breast cancer patient who had her health insurance policy dropped by the company after she became sick. The company dropped 1,600 policies between 2000 and 2006, avoiding paying $35.5 million in medical fees.
Ehnes and California Insurance Commissioner Steve Poizner have proposed new regulations that would require health care providers to find that customers deliberately misrepresented information on their applications before dropping their coverage.
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Posted by healthinsurance at 11:31 AM | Comments (0)
May 26, 2008
Polls show health care a growing concern for Californians
A new poll shows concerns over rising health care costs have kept pace with other major economic worries - second only to skyrocketing gas prices and tied with getting a job or raise that pays enough to cover increased living expenses.
The survey by the Kaiser Family Foundation, being released today, found that 44 percent of the more than 2,000 adults interviewed April 3 to 13 ranked paying for gas as a serious problem, compared with 29 percent for jobs and 28 percent for health care.
Difficulties paying for rent or mortgage followed at 19 percent, with food and credit card or personal debt close behind at 18 percent.
Health experts said the Kaiser poll, along with other studies released this week, show that health care remains in the forefront of Americans' concerns despite the mortgage crisis and growing overall economic woes. A Field Poll released Monday showed nearly 75 percent of Californian voters would have approved a health reform package brokered by Gov. Arnold Schwarzenegger and Democratic leaders that failed in the Legislature earlier this year.
"It is surprising to see that problems paying for health care are right up there with the top pocketbook issues that average Americans are facing and are much higher than some of the other problems you'd expect to see at the top of the list," said Drew Altman, president of the Kaiser Family Foundation, a health philanthropy in Menlo Park.
The poll showed that health care also plays a significant role in lifestyle decisions. Twenty-three percent of those surveyed said they or a member of their household either switched or stuck with a job because of health care benefits. Seven percent said that health care was a factor in their or a household member's decision to marry within the past year.
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Posted by healthinsurance at 02:26 PM | Comments (0)
May 22, 2008
California Insurance Department Encouraging Residents to Use Online Personal Health Records
Not enough California residents are using online personal health records offered by insurers and managed care groups in the state, according to a report released on Tuesday by the state Department of Insurance, the Sacramento Bee reports. The report was based on a survey of California's major insurers. The report states that PHRs are secure and efficient and allow people to better manage their health care and handle their health insurance claims. Based on the report, the state is encouraging residents to use PHRs. The department also is expected to announce the creation of a working group that would aim to ensure patients can keep their PHRs when they switch insurance companies.
Some privacy advocates have expressed concern about PHRs. Sue Blevins, founder and president of the Institute for Health Freedom, said, "While providing information is essential when seeking services, one shouldn't be forced to give up privacy and the freedom to withhold consent." Blevins said, "In fact, as the nation moves toward interoperable electronic medical records, it's important for citizens to gain greater privacy and control over their health care information." However, state officials on Monday said that the PHRs available through insurers in the state are securely managed (Glover, Sacramento Bee, 5/20).
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Posted by healthinsurance at 09:33 AM | Comments (0)
May 15, 2008
Kaiser patients to receive health coverage again
Kaiser Permanente today became the first California health plan to reinstate the individual insurance policies of consumers who were improperly dropped, often after running up expensive medical bills.
The California Department of Managed Health Care announced that Kaiser will offer coverage to 1,092 consumers whose policies were rescinded from 2004 until 2006, when Kaiser stopped the practice. The state has been investigating the five largest health plans for retroactively dropping consumers for making minor mistakes about their medical histories on their health insurance applications.
Kaiser will also pay a $300,000 fine.
One of those dropped consumers, Denise Fenton of Lake Forest said she bought an individual Kaiser policy because she’s self-employed. While insured, she was diagnosed with diabetes. Kaiser then dropped her, she says, calling her diabetes a preexisting condition.
“I was suddenly left with no insurance and now knowing I had diabetes I was going to have to disclose it, basically making it impossible for me to get health insurance from anyone else,” she said.
Fenton said she was able to form a corporation and then qualify for Kaiser insurance again, but at double the price.
Cindy Ehnes, director of the agency, said Health Net will be the next insurer to approve a similar plan to reinstate 85 consumers.
In addition to the offer to repurchase their insurance, Kaiser will reimburse those dropped for medical expenses accrued while they were insured, but that were not paid by Kaiser once their policies were canceled. Kaiser will also pay for medical bills incurred after consumers lost their health coverage.
Ehnes estimated that roughly 4,000 more Californians were rescinded by the other major health plans. The state is undertaking a review of patients from other health plans who were rescinded to determine if insurers should be ordered to reinstate them.
William Shernoff, a Claremont attorney representing several Orange County patients who are suing other insurers who dropped them, said though Kaiser wasn’t a big player, he hopes the other health plans will follow suit.
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Posted by healthinsurance at 01:59 PM | Comments (0)
May 13, 2008
California polls show health care a growing concern
A new poll shows concerns over rising health care costs have kept pace with other major economic worries - second only to skyrocketing gas prices and tied with getting a job or raise that pays enough to cover increased living expenses.
The survey by the Kaiser Family Foundation, being released today, found that 44 percent of the more than 2,000 adults interviewed April 3 to 13 ranked paying for gas as a serious problem, compared with 29 percent for jobs and 28 percent for health care.
Difficulties paying for rent or mortgage followed at 19 percent, with food and credit card or personal debt close behind at 18 percent.
Health experts said the Kaiser poll, along with other studies released this week, show that health care in California remains in the forefront of Americans' concerns despite the mortgage crisis and growing overall economic woes. A Field Poll released Monday showed nearly 75 percent of Californian voters would have approved a health reform package brokered by Gov. Arnold Schwarzenegger and Democratic leaders that failed in the Legislature earlier this year.
"It is surprising to see that problems paying for health care are right up there with the top pocketbook issues that average Americans are facing and are much higher than some of the other problems you'd expect to see at the top of the list," said Drew Altman, president of the Kaiser Family Foundation, a health philanthropy in Menlo Park.
The poll showed that health care also plays a significant role in lifestyle decisions. Twenty-three percent of those surveyed said they or a member of their household either switched or stuck with a job because of health benefits. Seven percent said that health care was a factor in their or a household member's decision to marry within the past year.
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Posted by healthinsurance at 11:54 AM | Comments (0)
May 08, 2008
Bush Administration Suggests Leeway on Kids' Health Coverage
The Bush administration on Wednesday sent letters to state health officials to clarify a policy directive issued last year that restricts states' ability to expand eligibility for their versions of the State Children's Health Insurance Program, CQ HealthBeat reports (Carey, CQ HealthBeat, 5/7).
According to guidelines issued in August 2007, before expanding SCHIP eligibility to children in families with incomes greater than 250% of the federal poverty level, states first must demonstrate they have enrolled at least 95% of eligible children with family incomes below 200% of the poverty level (California Healthline, 4/21).
According to the Wall Street Journal, most states do not meet the requirements, which has meant that several states, including New York and Ohio, have had to abandon their SCHIP expansion plans.
The letter sent Wednesday will qualify "many" of the states that did not meet the 95% requirement by using data from the Current Population Survey, according to Herb Kuhn, deputy administrator and acting director for the Center for Medicaid and State Operations at CMS (Zhang, Wall Street Journal, 5/8).
The recent letter says that states can use data on Medicaid, SCHIP or private insurance to demonstrate they had reached the 95% requirement.
"This is an achievable, goal and based on conversations with states, we are convinced that a number of states have already reached this goal," Kuhn wrote in the letter.
The letter also clarifies that the guidelines do not apply to children already enrolled in SCHIP. It also says that state health officials can recommend other ways to prevent families from substituting SCHIP coverage for private insurance, CQ HealthBeat reports (CQ HealthBeat, 5/7).
The guidelines currently say that states seeking to expand SCHIP eligibility must establish a minimum of a one-year period of uninsurance for individuals in families with incomes greater than 250% of the poverty level (California Healthline, 4/21).
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Posted by healthinsurance at 01:59 PM | Comments (0)
May 06, 2008
California health care workers sue state over pay-cut plan
A coalition of health care groups sued the state Monday to prevent pay cuts to doctors, dentists, pharmacists and others who treat the poor, elderly and disabled.
The lawsuit filed in Los Angeles County Superior Court on behalf of California health care providers seeks an injunction to halt 10 percent cuts to Medi-Cal and Denti-Cal reimbursements scheduled to take effect July 1.
"These specific cuts strike at the core of the safety net," said Erica Murray, vice president of the California Association of Public Hospitals and Health Systems. "These are the trauma centers, the burn units, the places where people go not only when they don't have insurance or they have Medi-Cal, but if they have an automobile accident, their house burns down or another tragic event."
The state Legislature approved the cuts in February as part of Gov. Arnold Schwarzenegger's plan to trim a $16 billion budget deficit. Health care providers objected and said reimbursements already fell short of their costs for treating 6.7 million Medi-Cal patients.
The governor's office projected in January that the program would cost $36 billion, including $13.6 billion from the state's general fund, but health care associations expect those numbers to grow by the time a budget is passed. Most of the program is paid for by the federal government.
"The governor fully understands the devastating impact of these cuts which is why he continues to push for comprehensive health care reform and structural budget reform," said Lisa Page, a spokeswoman for Schwarzenegger.
The coalition, which is seeking class-action status, is optimistic it will prevail in its case against the Department of Health Care Services, said attorney Craig Cannizzo. He said lawmakers need to understand that Medi-Cal is not "a pot of money that they can steal from any time."
A similar lawsuit five years ago halted a 5 percent Medi-Cal cut proposed by Gov. Gray Davis.
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Posted by healthinsurance at 12:15 PM | Comments (0)
May 01, 2008
California Can Learn Health Care Lessons From Down Under
The health care reform is still on the table in California, which should consider carefully the achievements and failings of foreign systems. Canada is the usual candidate but Australia’s health care strategies deserve a closer look.
The negative effects of Australia’s government-run health system are predictable and apparent: limited distribution of technology, restrictions on the number of medical students and Medicare providers, and waiting lists. Recognizing this, the country recently reformed private health insurance – which is not mandatory – in order to attract more Australians to sign up.
Australian taxpayers finance almost 70 percent of total health care expenses, including a subsidy for private health insurance, under which almost half of the Australian population is now covered. Taxes fund a 30-percent rebate on private insurance premiums for Australians under the age of 65. Rebates go up to 40 percent for older patients.
Australia phased in a Private Health Insurance Incentives Scheme (PHIIS) to improve citizens’ access to care, which caused the number of privately insured Australians to rise from 31 to 46 percent. The plan incorporated several reforms. Most importantly, it allowed age-rating in private health insurance, which was previously forbidden.
With age-rating, insurers started charging lower premiums for younger people, attracting them to purchase policies. To manage the transition, those above 30 who signed up before a cut-off date in 2000 were also given a discounted premium. Those who did not sign up in time would pay higher premiums equal to the base discounted premium plus 2 percent for every year after age 30.
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Posted by healthinsurance at 02:29 PM | Comments (0)
April 29, 2008
California Above U.S. Average for Health Insurance Cost Increases
The cost of health insurance premiums for coverage through private-sector jobs increased more than 10 times faster than employees' incomes from 2001 to 2005, according to a report released Tuesday by the Robert Wood Johnson Foundation, the Washington Post reports (Washington Post, 4/29).
In California, health insurance costs for the average family increased by about 34%, from $7,898 in 2001 to $10,551 in 2005, according to the study. During that period, salaries increased by about 9% on average for California workers.
California's jump in health insurance costs gives it the 12th-largest increase in the nation. The national average increase in health care costs was 30%, according to the study (Colliver, San Francisco Chronicle, 4/29).
Study Methodology
Researchers from the State Health Access Data Assistance Center at the University of Minnesota analyzed data from the U.S. Census Bureau and the Medical Expenditure Panel Survey conducted by the Agency for Healthcare Research and Quality to compile the report (Forster, St. Paul Pioneer Press, 4/28).
The information was released in conjunction with National Cover the Uninsured Week (Anstett, Detroit Free Press, 4/29).
National Findings
According to the report, monthly premiums for family coverage increased 34.6% from $1,921 in 2001 to $2,585 in 2005, while median family income rose 3.1% from $40,818 to $42,068 during the same period (Washington Post, 4/29).
The report also found that employees nationwide are paying a larger percentage of their insurance premiums -- 24.1% in 2005 compared with 23.2% in 2001 (Park, Arkansas Democrat-Gazette, 4/29).
According to the report, the number of people with private coverage dropped by about 6% nationally, while the number of private-sector employers who offered health insurance declined by 0.8% nationally (St. Paul Pioneer Press, 4/28). Premium increases contributed to 2.4 million fewer U.S. residents with private health coverage in 2005 than in 2001, according to the report (Krouse, Cox/Raleigh News & Observer, 4/29).
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Posted by healthinsurance at 04:16 PM | Comments (0)
April 24, 2008
Insurance reinstatement orders put health plans on edge
Last week’s move by state regulators, opening the door to restoring health insurance to thousands of customers who had their coverage cancelled by health plans, has the health care world waiting to see what will happen next.
The plans say they are still waiting for word from the Department of Managed Health Care about which 26 customers have been ordered to have their health care coverage restored. Thousands of other cases will be reviewed by an arbiter, selected by the department.Representatives from various health plans said they expect the broader review of these cancellations to be challenged in court. Though none would speak for attribution, they said they are waiting to see the details of the process established by the department before commenting on any potential legal action.
The department ordered the reinstatement of 26 patients who had their health coverage cancelled by Blue Cross, Blue Shield and Kaiser. More reinstatements may be ordered as the department winds up its investigation of HealthNet and PacifiCare.
Blue Shield and Kaiser said the department made the public announcement before revealing to the plans which patients were being reinstated. It was unclear whether the plans would fight those specific reinstatements.
“We are in the process of contacting them,” said DMHC spokeswoman Lynne Randolph. She said the DMHC had contacted the health insurance plans for information on cases, and would issue the formal reinstatement orders shortly. “We should have it wrapped up by the end of the week,’” she said.
DMHC Director Cindy Ehnes said her office would review cancellations between 2004 and 2008. “Every single rescission will be reviewed by this department,” Ehnes said, adding that patients would be compensated for their costs in the event the rescission was flawed. “For the first time, we are giving people a second chance to get that health coverage,” she said.
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Posted by healthinsurance at 02:38 PM | Comments (0)
April 22, 2008
California Health Insurers Must Reinstate Policies
Chalk one up for sickly patients. California regulators have ordered insurers there to reinstate the health insurance policies of 26 people who lost their coverage after the insurers claimed they had lied on their applications, according to news reports. The 26 cases represent the most egregious examples of insurers wrongly "rescinding" policies, typically for inadvertent errors. The person gets sick and starts making expensive claims, and the insurer cries "fraud!" The patient says "forgot!" or sometimes "say what?" For example, one woman I spoke with on this topic had answered "no" when asked if she'd been treated for cancer in the past 10 years. Later her policy was yanked because the insurer claimed that regular blood work she had to ensure her earlier cancer hadn't returned constituted cancer treatment.
Now California begins a case-by-case review of thousands of rescissions in the past four years, and it may be that these 26 are the tip of a fairly hefty iceberg. And consumer advocates say there's no reason to believe this issue is confined to California. They expect similar cases to begin emerging elsewhere.
These problems arise in the individual health insurance market, where people buy policies on their own. That market is much more loosely regulated than the group market—and often more problematic for patients—as I discussed a few months ago.
Right now, only about 5 percent of people buy insurance this way. But if Sen. John McCain has his way, many more would very likely start buying insurance on their own. The presumptive Republican nominee has proposed eliminating the tax break that employees currently get on their health insurance benefits and instead giving people a tax credit of $2,500 for individuals and $5,000 for families to put toward buying coverage. I also wrote today about the presidential candidates' healthcare reform proposals.
Many policy analysts see merits to the restructuring that McCain proposes, but they argue that without better regulation of the individual market, people who are older or sick won't be able to get affordable health coverage, or any coverage at all. They point to what's going on in California as an example of the kind of problems that can occur. "Look at the rescission mess in California," said health policy analyst Robert Laszewski, when I interviewed him for the election health reform piece. "The Democratic nominee will stand up and say, 'John McCain will throw you to the market wolves.' " McCain is expected to elaborate on his healthcare reform proposal at the end of April. Maybe at that time he'll offer details about how he plans to protect consumers from predatory insurance practices.
As for this rescission mess, I'd like to hear from people who've experienced problems similar to what's occurring in California. Is this just a left coast phenomenon, or is it happening elsewhere, too?
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Posted by healthinsurance at 02:38 PM | Comments (0)
April 17, 2008
Los Angeles Files Lawsuit Alleging Anthem Blue Cross Illegally Canceled Health Insurance Policies
Los Angeles City Attorney Rocky Delgadillo on Wednesday filed a lawsuit against Anthem Blue Cross alleging the insurer violated more than 25 state and federal laws and "sold people false promises of coverage and concealed a scheme to renege on policies for those diagnosed with serious and often expensive medical conditions," the Los Angeles Times reports. Delgadillo claims the insurer issued false promises of coverage and concealed a plan to rescind the health insurance policies for patients diagnosed with serious and costly medical conditions. The suit seeks restitution for patients left with medical bills and more than $1 billion in penalties.
The lawsuit claims that the company's coverage "is largely illusory." Delgadillo said Anthem "engaged in an egregious scheme not only to delay or deny the payment of thousands of legitimate medical claims but also to jeopardize the health of more than 6,000 customers by retroactively canceling their health insurance when they needed it most." He added, "Countless Californians who believe they have good health insurance actually have policies that aren't worth the paper they're printed on."
The charges cited by the suit include some allegedly illegal activities reported by a Times article highlighting the rescission of policies held by individuals with costly medical conditions. Jerry Flanagan, a patient advocate with Consumer Watchdog, said, "The complaint makes it very clear that a key part of the resolution will be to make sure everyone has coverage."
Cindy Ehnes, director of the state Department of Managed Care, on Thursday is expected to announce that rescinded policies of several individuals would be reinstated by health care plans and to describe a process by which other patients could have rescissions reviewed and reconsidered. State Insurance Commissioner Steve Poizner said he would examine the allegations and decide whether action is needed.
A spokesperson for Anthem's parent company, WellPoint, said the company "strongly disagrees with the allegations" and plans to defend itself. "Anthem has offered on several occasions to meet directly with the city attorney to provide further information on Anthem's rescission procedures," said Shannon Troughton of Wellpoint. "To date, the city attorney rejected each of these offers, and we are disappointed by his actions today because of our attempts to meet with him," she added.
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Posted by healthinsurance at 11:53 AM | Comments (0)
April 11, 2008
Two health-care rescission bills make way through Assembly
The battle over how and when health plans can cancel a patient's insurance policy returned to the Capitol this week as two key pieces of legislation cleared the Assembly Health Committee.
At issue are the rules health insurance companies must abide by before they cancel a patient's health care coverage.
"In the five years that we have records, there have been about 700 rescission per year," says Hector De La Torre, D-South Gate, author of one of the bills passed out of Health Committee this week. "This bill would make it so those rescissions would have to be reviewed by a third party before they can happen."
Under current practice, health plans have the authority to unilaterally rescind a policyholder's insurance if they find there has been a "willful misrepresentation" of the patient's medical history on their initial health care application. De La Torre's bill would force health plans to seek approval from a third-party arbiter before an enrollee's health insurance policy can be revoked.
A number of high-profile cases in recent years have found that health insurance plans have improperly revoked policies from insurance holders for accidental omissions on their health insurance applications.
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Posted by healthinsurance at 05:43 PM | Comments (0)