Health Insurance ~ Current News

Anthem Blue Cross seeks rate hike

2010-07-01T04:52:00.000-07:00

How will you pay for your own Long Term Care Needs?

2010-04-15T14:40:00.000-07:00

Published: April 13, 2010 9:21 a.m.
Plan for long-term care needs
By JANE GLENN HAAS
SPECIAL TO THE REGISTER

"Five years after Terri Schiavo's family battled to let her die by having her feeding tube removed, the "be prepared" lesson has been learned by fewer than 30 percent of the seniors."

Click HERE to read the complete story from the OC Register.

Email me julia@crossins.com for more information on how to purchase a Long Term Care Insurance Policy for you or for a loved one.

Cheers ~ Julia

Fed Health Care Reform: Impacts on Employers

2010-04-10T17:41:00.000-07:00

How does President Obama's Federal Health Care Reform Impact Employers?

2010 has brought the most sweeping reforms to health care coverage since Blue Cross and Blue Shield plans began almost 75 years ago. The new "Patient Protection and Affordable Care Act", with over 2,000 pages of new federal law, will touch virtually every facet of the health care industry.

The Act makes significant changes to the health and other benefits that employers offer to their employees. Additionally, there are administrative requirements required in the act with which an employer will need to comply or they risk expensive penalties. These changes will be phased in over the next 4 years, however many of the changes are either retroactive or begin immediately.

Employers ~ Be sure to watch your email & snail mail for up todate information from your Group Health Administrator.

Cheers ~ Julia

Do you need International Health Insurance?

2010-03-23T13:35:00.000-07:00

International Health Insurance ~ I am excited to introduce you to an insurance product (that is new to me) that is brought to you by "HTH Worldwide".

HTH (Highway To Health) Worldwide understands that (inspite of the President's recent $trillion Health Insurance reforms) domestic (US based) health insurance still (& always will) ends at the US border. HTH also understand that every country, city and hospital in the world has their own unique way of handling international travelers who find themselves in need of Medical Care.

How will you get home to the US if you are too injured to travel?
How will your family get to you if you are too injured to travel?
How many days will you spend in the hospital if you have your emergency surgery in Russia?
Where do you go in Switzerland to refill your migraine medication?
Should the Chinese Doctors inject your injured knee with stem cells?

If you are planning a trip overseas for any of the following reasons or any amount of time, you will definately want to investigate your options for International Health Insurance:

1wk-6 mos Vacation ~ Are you planning to spend July spectating the 2010 Tour de France & need to insure your luggage and your health?

6-12 mos Vacation ~ Are you planning an extended back pack or bicycle tour of Europe in search of yourself and need to know where to go in Italy for Allergy meds or to refill you Insulin prescription?

12+ mos Relocation ~ Are you planning to move to your 2nd home in Italy as you seek permanent employment and need to know that you have full medical insurance in the event you discover that you have cancer or are injured in a car accident?

Foreign Exchange students
Atheletes
Corporate Employees
Missionaries
Globetrotters
Immigrants

Whatever your reason for being overseas, however long you plan to stay, PLEASE do NOT buy your plane ticket without securing either a short-term or long-term International Health Insurance Policy!

Please click on the International Insurance links provided on the left side of this screen to get started now!

Thanks for asking!!
Julia Cross
0B28378

New Premier PPO Plans for Spring 2010

2010-03-02T08:24:00.000-08:00

Anthem Blue Cross is excited to offer the PREMIER plans. These plans offer many benefits before the annual deductible including preventive care and prescription drugs! With the lowest level of coinsurance (25%) across all deductibles, the Premier PPO Plans offer added value over other plans we offer.

Some important Plan features:

• Unlimited doctor office visits with predictable co-pays ($30 for primary/family physicians and $50 for specialists) that are not subject to the annual medical deductible.
• A broad range of preventive benefits before having to meet the annual deductible helps focus on keeping you healthy. This includes an Annual Physical Exam, Routine Mammogram, Pap, PSA and Well Child Care with a $30 co-pay.
• Annual routine eye exam.
• $7 million lifetime benefit per member.

This is a great plan designed for busy families that need a variety of benefits.

Please email me for more information on these plans or to apply for coverage now.

Cheers ~ Julia
julia@crossins.com

More Health Care Reform Proposals

2010-02-22T08:17:00.000-08:00

How much government control is too much?

Just in time for Thursday's White House health care Summit, President Obama wants the goverment to have the power to:

a) "deny or roll back egregious insurance premium increases that infuriate consumers"
b) "require most Americans to carry health insurance coverage".

Really? Yes, really!!

The complete article can be found at http://abcnews.go.com/m/screen?id=9905984&pid=74
Additional related articles => http://fluentnews.com/s/23490126

Cheers ~ Julia

March 1st Rate Increase Postponed to May 1st

2010-02-17T11:09:00.000-08:00

Anthem Blue Cross Life and Health Insurance Company has agreed to a request by the California Dept of Insurance to postpone their March 1, 2010 rates to May 1, 2010, pending an additional third-party review.

The review will be conducted by Axene Health Partners, LLC, retained by the Ca Dept of Insurance.

Anthem Blue Cross "...welcomes the additional scrutiny by the commissioner..."

Anthem BC is sending pre-recorded messages & mailing written notificiation to all existing clients with an individual/family policy beginning Feb 16th with addtional details. FYI ~ ABC is calling me now and I am listening to the pre-recorded phone message while I type this. :)

As of March 1st, all clients will be billed at their prior rate of premium. A system of refunds will be established for those who have already paid their March 1st premium at the higher rate.

If you have any questions, please contact me at julia@crossins.com or call Anthem Blue Cross directly at 1-800-333-0912 (you should expect a longer wait time for calls).

Please note: This action does not affect any Senior or Group Products!

Cheers ~ Julia
0B28378
Authorized Blue Cross Agent since 1998

New Family Leave Regulations

2010-02-09T09:55:00.000-08:00

New FMLA Regulations Expand Military Caregivers' Coverage

The Family and Medical Leave Act of 1993 ("FMLA"), which applies to employer groups with 50 or more employees and all public agencies, has an indirect impact on health insurers and group health plans.

In 2009, Congress enacted new legislation, HR2647, which became effective on October 28, 2009. It applies to all FMLA leave requests submitted on or after that date.
Specifically, HR2647 does the following:
· Expands the exigency leave entitlement to include family members of the regular Armed forces, who were not entitled to exigency leave under the prior law;
· Expands the military caregiver leave entitlement to include veterans, who were not covered under prior law; and
· Expands the military caregiver leave entitlement to include leave to care for a service member or veteran whose preexisting serious injury or illness was aggravated by active duty service.

More information on FMLA and HR4986 legislation is available online at http://www.dol.gov/whd/fmla/finalrule.htm. Employer groups requesting more compliance information on FMLA should be referred to their own legal counsel.

2 New Individual Anthem Blue Cross Products

2010-02-04T19:11:00.000-08:00

Anthem Blue Cross is pleased to announce 2 new Individual Insurance Products for 2010!

Anthem’s “Clear Protection” and “Core Guard” have been designed to give you the coverages that are most important to you and your family without breaking the bank.

Is “Clear Protection” the right plan for you? Are you looking for a lower cost plan with immediate coverage for some doctor visits and long-term coverage for other benefits you may need? Clear Protection could be the right plan for you with 3 deductibles to shoes from and moderate cost-sharing helps lower your monthly premiums. Clear Protection offers up to $4 million per member in lifetime benefits.

Is “Core Guard” the right plan for you? Are you looking for a simple plan designed with some of our lowest rates? Core Guard could be the plan that’s right for you. Core Guard offers a wide range of deductibles and higher cost sharing designed to lower your monthly premiums. Core Guard offers up to $4 million per member in lifetime benefits.

With both plans, you have some choice and flexibility to change the plan to better meet your needs including Deductible, Coinsurance and other Optimal Coverages.

Please click on the Quote/Apply links on the left and chose your coverages now or email me immediately for additional information!

Click HERE for an outline of Anthem's traditional policies.

Cheers ~ Julia

Doctor says universal health care plan necessary....

2009-10-29T13:29:00.000-07:00

"Dr. Steele offered some prescriptions for controlling individual (health/medical) costs.

The top three were control weight, quit smoking and get active.

“The No. 1 determinant of health care spending is weight,” he said."

The complete article can be viewed in the Oct 29, 2009 edition of the Bangor Daily Newspaper.
rhewitt@bangordailynews.net

Free Health Care in LA thru Tues 8/18/09

2009-08-14T13:15:00.000-07:00

Free, comprehensive health care available
August 14th, 2009, 6:00 am · 3 Comments · posted by Courtney Perkes
From the OC Register ~ http://healthyliving.freedomblogging.com/2009/08/14/free-comprehensive-healthcare-available/9059/

Remote Area Medical, a Tennessee-based nonprofit, is offering free medical, dental and eye care through Tuesday at the Forum in Inglewood.

It’s the first time the group, which has been featured on “60 Minutes,” has provided care in a major urban area. And huge, LA-sized crowds are clamoring for eyeglasses, mammograms and root canals.
All services are provided by volunteer doctors, dentists and nurses. Here’s the rundown:

DENTAL: Cleanings, fillings, extractions, and root canals. Everyone receives a free dental exam. Pediatric dentistry is available.

VISION: Vision exam and free prescription glasses made on site. (NOTE: May not be able to make glasses for everyone.) Cataract surgery.

MEDICAL & WOMEN’S HEALTH: Mammograms and Pap smears; pediatric exams; adult physicals & medical consults (including diabetes and hypertension); chiropractors; acupuncture; blood lab work; chest X-rays; medication assistance; and many other medical specialties available.

The massive clinic opens each morning at 5:30 a.m.
Wait times are long. Read more here on what to expect.
The Forum is located at 3900 West Manchester Blvd., Inglewood.

A New York Times article on the clinic includes an Orange County family, with health insurance, who visited the clinic because they can’t afford their dental insurance deductibles. The dental services are particularly valuable with California’s July 1 cut to Medi-Cal’s adult dental program.
Good oral hygiene is important for overall health in areas as varied as heart disease and pregnancy

Pay the rent or keep the Health Insurance?

2009-07-10T10:34:00.000-07:00

Friday, July 10, 2009
Health coverage or rent? O.C. residents must choose
BY COURTNEY PERKES
The Orange County Register

It's nearly impossible to grasp a number like America's annual $2 trillion medical bill.
So as Shari Carter avidly follows news from Washington on the summer of health care reform, she thinks about $1,059 — the monthly amount that cost Carter her HMO.

"I've never gone without insurance," she said. "It's scary. I'm at the age where they want to get rid of you real bad."

<<click here to read the complete story>>

Medical Bankruptcies on the Rise

2009-06-09T11:27:00.000-07:00

Medical bankrupties on the rise
June 9th, 2009, 6:00 am · 4 Comments · posted by Courtney Perkes

A new study from Harvard University finds that 62 percent of bankruptcies are caused by medical bills - a 50 percent increase since 2001. Based on that rate, medical bankruptcies this year will total 866,000 and involve 2.3 million Americans – about one person every 15 seconds.

The complete story can be found in The OC Register.

Cheers ~ Julia

Anthem Blue Cross Suspends Part D Products

2009-06-04T10:20:00.000-07:00

CMS Orders Temporary Suspension of our Medicare Advantage and Medicare Part D Products.
On January 12, 2009 the Centers for Medicare and Medicaid Services (CMS) ordered Anthem Blue Cross to temporarily suspend enrollment and marketing of our Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD) and Prescription Drug Plan (PDP).

We have been working with CMS for several months to resolve issues identified as a result of a recent CMS audit, our own self-audit, and issues stemming from our members’ ability to access their pharmacy benefits. Our plan is to continue working with CMS to make the necessary business improvements in our operations and processes as quickly as possible so that we can re-enter the market in a position to better serve our current and future Medicare members.

The MA, MAPD and Medicare Supplement members we currently serve can continue to count on us to provide their health benefits. We will continue to sell our Medicare Supplement products.

Westcliff Labs accused of overcharging.

2009-03-20T16:28:00.000-07:00

Friday, March 20, 2009
Medical lab sued by the state of CA for overcharging. State says Medi-Cal was billed as much as six times the price for testing.
By COURTNEY PERKES
The Orange County Register

The state Attorney General on Friday said it has sued a Santa Ana lab accused of overcharging Medi-Cal, the insurance program for the poor.

Please see the OC Register for the complete article.

The Uninsured Crisis

2009-02-26T10:18:00.000-08:00

Local community clinics and public hospitals see big jump in uninsured patients
By Sandy Kleffman
Contra Costa Times
Posted: 02/24/2009 08:00:00 AM PST

Growing waves of uninsured patients are flooding local community clinics and public hospitals, increasing pressure on the East Bay's frayed health care safety net.
Many of the newly uninsured lost their health coverage when they lost their jobs.

Julia

Blue Cross of CA Settles Claims

2009-02-12T08:07:00.000-08:00

Anthem Blue Cross (of CA) is agreeing to a settlement with California regulators, the latest pact reached by insurers over the issue of canceling insurance plans after patients got sick.

http://blogs.wsj.com/health/2009/02/11/anthem-blue-cross-settles-over-canceled-coverage-in-california/

The insurer, owned by WellPoint, has agreed to pay a fine of $1 million and to offer new coverage to 2,330 after they incurred big medical bills, the Los Angeles Times reports. The company will also reimburse them for medical bills they paid after their coverage was dropped, at a cost Anthem said could hit $14 million, the newspaper adds.

http://blogs.wsj.com/health/2009/02/11/anthem-blue-cross-settles-over-canceled-coverage-in-california/

Please see the Wall Street Journal (Feb 11, 2009) for the complete article.

Julia

2009 HSA Contribution Limits

2008-11-12T11:24:00.000-08:00

HSA contributions for 2009 ~ HSA contribution maximums (for January 1, 2009 effective dates) are not limited by either your plan's provider or your plan's deductible.

They are set & adjusted annually by the IRS:
$3,000 for individuals
$5,950 for families

Julia

Presidential Healthcare Debate....

2008-11-02T10:12:00.000-08:00

Barack Obama and John McCain couldn't disagree more on what is needed to fix the nation's health care system. Obama believes government still needs to be heavily involved in making sure people have insurance. McCain wants a system rooted in the free market.
read the complete OC Register article 11/2/08

Medical bills take toll on personal finances

2008-07-12T09:45:00.000-07:00

According to researchers at Harvard University, medical bills contribute to roughly half of all bankruptcies. They also say the chain of events leading to bankruptcy is often easy to trace – an unforeseen illness or accident that leads to the loss of a job, and with it, the double whammy of losing health insurance and income.

While most Americans will never file for bankruptcy, paying for health care is a source of worry for many.

The complete article was printed in the Orange County Register on 7/12/08.

Have you ever been sick?

2008-04-12T18:05:00.000-07:00

Friday, April 11, 2008
Have you ever been sick?
Insurers face increased scrutiny for picking apart clients' medical records and canceling policies after expensive treatment.
BY COURTNEY PERKES
The Orange County Register

Contact the writer: 714-796-3686 or cperkes@ocregister.com

How to: Get Better Cheaper Health Care w/o Insurance

2008-03-20T08:29:00.000-07:00

How to: Get Better, Cheaper Health Care Without Insurance (25 Tips, Tricks and Resources)
Published on Wednesday March 19th , 2008
By Christina Laun
Health care has been at the forefront of political and popular debate more than ever as costs continue to rise in the face of an unstable economy. With rising energy costs, falling real estate prices, and no national health care system, many people simply have to learn to do without the medical care they need. There are, however, ways to save on health care costs without having to sign up for a pricey insurance plan. Here are a few tips for saving your healthcare dollars, as well as a number of information sources for localized, low-cost healthcare.

Click Here for the complete article.

Julia

Little assurance for insurance firms

2008-02-11T04:09:00.000-08:00

http://www.ocregister.com/news/ciga-williams-presentation-1976851-jacobson-board
BRIAN JOSEPH
Register columnistCAPITOL WATCHDOG bjoseph@ocregister.com
Comments 0 Recommend 0
SACRAMENTO – The California Insurance Guarantee Association may be the most important bureaucracy you've never heard of.
Founded under legislation in 1969, the association acts as a sort of insurance for insurance companies. If your provider goes broke, CIGA picks up your claim.

"Without CIGA, we would have been in an absolute financial disaster when the workers comp crisis hit," said Michael Mattoch, an executive with USAA Financial Services. He describes CIGA as crucial piece of California's infrastructure.

So would it worry you that CIGA is $1.6 billion in the red and plagued by infighting and potentially gross mismanagement?

http://www.ocregister.com/news/ciga-williams-presentation-1976851-jacobson-board

CIGA says it ran into trouble when the workers comp crisis forced it to pick up thousands of claims, but a recent audit by an Alhambra CPA suggests another culprit: misconduct.

In November, accountant John F. Williams made a PowerPoint presentation to the CIGA board that described an organization in disarray. He found contracts awarded without bidding, claims paid without review, a vendor the association should terminate "ASAP." Williams concluded that of $66 million spent on bill review fees, CIGA had overpaid $55 million.

"My jaw was on the table," said Dan Jacobson, an Orange County attorney who was appointed to the CIGA board by then-Insurance Commissioner John Garamendi in June 2006. "Before Mr. Williams' presentation, I had a sense there were some things that needed to be fixed at CIGA. I had no idea it was this horrible."

Williams, who was hired by CIGA management to conduct the audit, declined to speak with me, but I obtained a copy of his slideshow.
Marked "Confidential," the presentation states "contract negotiations [are]ad hoc, personal, and informal" and adds, "Some relationships have no contracts." It recommends that CIGA implement the most basic of procurement policies, such as bidding for services.

Williams' presentation also focuses on independent companies, or so-called "third-party administrators," employed by CIGA. Third-party administrators handle claims for CIGA and the slideshow suggests that not only did CIGA enter into bad agreements with them but also that some may have business relationships which could allow them to bleed CIGA.
The presentation states CIGA's "bill review fees are very high" because instead of paying the administrators a flat fee, they are paid a percentage of the savings they uncover.That practice is so questionable that Joe Coto, chairman of the Assembly Insurance Committee, is introducing a bill to outlaw it.

The presentation adds that a couple of the third-party administrators are affiliated with the very vendors billing CIGA. That means, effectively, that the same companies billing CIGA are also ensuring that the bills are accurate.

http://www.ocregister.com/news/ciga-williams-presentation-1976851-jacobson-board

"It seemed to validate my concerns raised at my first Investment and Audit Committee meeting when I discovered that they were not auditing the billing and substantive case handling of their compensation defense firms," said Steve Testan, a founder of a national workers comp defense firm who was appointed to the CIGA board by Assembly Speaker Fabian Núñez in June 2007.

"As to the entirety of Williams' presentation, I was shocked. The association is dealing with public assessment monies."
Testan and Jacobson, two of newest members of the 13-member board, were obviously troubled by Williams' report, but say the board's chair and vice chair and CIGA management have blocked them from doing anything about it.
http://www.ocregister.com/news/ciga-williams-presentation-1976851-jacobson-board

In letters to numerous state officials, including Núñez, Insurance Commissioner Steve Poizner, Attorney General Jerry Brown and Orange County Sen. Lou Correa, Testan and Jacobson allude to "Herculean efforts … undertaken by the powers that be" to prevent them from speaking with Williams and add that CIGA may have paid more than $200 million in unaudited legal fees.

One letter concludes that the actions of CIGA leadership suggest "waste and mismanagement" if not "something more sinister."
The infighting has become so fierce that the vice chairman, Jim Sevey, even asked Jacobson to resign after Jacobson raised concerns about a potential conflict of interest involving CIGA's legal counsel. Jacobson declined.

http://www.ocregister.com/news/ciga-williams-presentation-1976851-jacobson-board
"When I've tried to access simple information that I need to perform my job – like Mr. Williams' phone number – I've been met with a management brick wall," Jacobson said.

I can understand their frustration. I tried to attend a CIGA meeting last week at the high-rise Bankers Club of San Francisco, but I was thrown out almost as soon as I arrived.
I had barely removed my coat and sat down when the executive director, Wayne Wilson, glared at me from across the room. Who are you? he demanded as he loomed over my chair. This meeting is private, he said.
I explained that I thought I should be allowed to stay because CIGA was established under statute, its members are appointed by elected officials and it's funded by assessments on California insurance policies.

Wilson didn't care about my reasons and didn't care when I identified myself as a Register reporter. He wanted me gone.

My research had indicated there is some disagreement over whether open meetings laws apply to CIGA, so I asked Wilson to cite the authority for making me leave. He refused, then told me to get out.
I later spoke with Wilson after he returned to CIGA headquarters in Glendale. He told me there are "substantial question marks surrounding" Williams' presentation and suggested that the auditor didn't fully understand CIGA.

http://www.ocregister.com/news/ciga-williams-presentation-1976851-jacobson-board
For example, he said CIGA doesn't bid for services because when an insurer goes bankrupt it has to react quickly.
"You can't stop paying benefits to an injured worker," Wilson said. "That's one of the issues Mr. Williams never got a grip on."
Wilson dismissed allegations of overspending as one man's opinion and added that the claims of some CIGA critics may prove to be "over the top."
"There's nothing sinister … going on," he said. "The board is actively and aggressively working on issues that have been identified."
I also tried to speak with Jim Sevey, the vice chairman, and with Chairwoman Linda R. Smith, but both referred me to Wilson.

Not everyone is silent, however. At the same meeting where I was tossed, Testan announced that he had offered his resignation to Núñez because of "irreconcilable differences" with certain board members.
"Information uncovered during my tenure … suggests that CIGA, to put it mildly, has some very serious issues to deal with," Testan wrote in a letter to Núñez. "Californians need a properly functioning CIGA."
Sen. Correa, meanwhile, has taken an interest in CIGA. Last week, he asked the Joint Legislative Audit Committee to launch an investigation.

"This is scary stuff," said Correa, a Democrat who represents Santa Ana. "This thing makes its living off an assessment on businesses. I only hope that they're applying best business practices," he said.

I don't think we've heard the last of this. Stay tuned.
Brian Joseph covers Capitol issues for the Register. His Capitol Watchdog column focuses on government practices. To reach him, call 916-449-6046 or e-mail bjoseph@ocregister.com.
http://www.ocregister.com/news/ciga-williams-presentation-1976851-jacobson-board

HealthCare Partners joins BC Select HMO network

2008-01-31T08:03:00.000-08:00

HealthCare Partners joins
Blue Cross Select HMO network
Effective January 1, 2008, HealthCare Partners officially joined the Blue Cross Select HMO provider network alongside its other prestigious partners.
Giving members access to an extensive network of excellent, contracted providers and quality, cost effective coverage is always a top priority within the Select HMO network, and the inclusion of HealthCare Partners helps attain this goal. A multi-specialty medical group dedicated to the well-being of members and their communities, HealthCare Partners has more than 40 convenient medical offices, including five urgent care centers and hundreds of affiliated medical offices located throughout the Greater Los Angeles and Orange County area. By giving members access to more than 800 Primary Care Physicians, the addition of this medical group will help retain existing business while also attracting new members.
HealthCare Partners has long been a participating medical group with Blue Cross. This change expands our relationship and makes this marquee group available to our Select HMO members. HealthCare Partners is currently available on ProviderFinder.

PacifiCare accused of widespread violations.

2008-01-30T09:35:00.000-08:00

PacifiCare accused of widespread violations
It could face $1.3 billion in penalties for allegedly mishandling claims.
The Associated Press

SAN FRANCISCO – Health insurer PacifiCare could face as much as $1.3 billion in penalties for allegedly handling claims unfairly following its takeover two years ago by UnitedHealth Group Inc., state officials said today.
http://www.ocregister.com/news/claims-pacificare-violations-1969293-unitedhealth-care
California regulators investigated and uncovered at least 130,000 alleged violations of state laws and regulations regarding payments for medical care, California Insurance Commissioner Steve Poizner announced in a statement.
A maximum penalty of $10,000 applies to each violation, which include wrongful denials of covered claims, incorrect payments, lost documents and delays in handling claims.
"After years of broken promises to California regulators, it became crystal clear that PacifiCare simply could not or would not fix the meltdown in its claims-paying process," Poizner said.
Minneapolis-based UnitedHealth purchased Cypress-based PacifiCare for $9.2 billion in January 2006. More than 3 million Californians were added to UnitedHealth in the deal. The company now has about 27 million enrollees nationwide.
http://www.ocregister.com/news/claims-pacificare-violations-1969293-unitedhealth-care
UnitedHealth officials said problems occurred when the company tried to make too many changes too quickly.
"The pace of the transition may have resulted in some physicians and other care providers experiencing inconsistent service in the past," spokesman Tyler Mason said.
PacifiCare had already disclosed many of the issues raised by regulators prior to the investigation and was taking "aggressive steps" to make improvements, Mason said.
http://www.ocregister.com/news/claims-pacificare-violations-1969293-unitedhealth-care
PacifiCare was also fined $3.5 million by California's Department of Managed Health Care over the alleged violations.
Department of Insurance investigators reviewed PacifiCare claims processed between July 2005 and May 2007 following complaints from patients and doctors, Poizner said.
http://www.ocregister.com/news/claims-pacificare-violations-1969293-unitedhealth-care
The maximum fine will apply only if authorities prove all the violations and show they were committed as part of a deliberate scheme.
UnitedHealth's regional chief executive David Hansen said the "vast majority" of the violations were administrative errors that did not harm PacifiCare members. More than 80,000 of the violations, he said, stemmed from not sending health care providers letters acknowledging that claims were received, even though most of those claims were paid on time, he said.
http://www.ocregister.com/news/claims-pacificare-violations-1969293-unitedhealth-care

Blue Cross of CA to become Anthem Blue Cross

2008-01-02T08:30:00.000-08:00

Blue Cross of California to become Anthem Blue Cross

Starting April 1, 2008, Blue Cross of California will begin to do business as Anthem Blue Cross, taking on a trusted brand name that symbolizes quality for millions of consumers across the country.

This means Blue Cross of California products and services will be offered under the Anthem Blue Cross brand. Blue Cross of California’s affiliate, BC Life & Health Insurance Company, will also adopt the Anthem brand and change its name to Anthem Blue Cross Life and Health Insurance Company.

The brand change to Anthem will apply to our complete product portfolio, including medical, dental, vision, life, employee assistance programs and behavioral health services.

The Anthem brand, used by 11 other health plans across the country, is well recognized and known for quality, affordable health care coverage. With a strong reputation in the market as a trusted choice for consumers, the Anthem brand name embodies the same consistency, strength, security and stability as the Blue Cross of California name.

Stay tuned for more information as it becomes available.

Julia

New Years bring New Laws to CA

2007-12-31T16:07:00.000-08:00

By BRIAN JOSEPH
The Orange County Register
SACRAMENTO – It's Jan. 1, a time for hangovers, resolutions and … new state laws.
Unbeknownst to most Californians, hundreds of new laws go into effect every New Year, although many amount to nothing more than minor or technical changes to state programs or statutes.
A few, however, can be felt across the golden state. Here's a look at some that may be of interest to you.

Minimum wage: Fast food workers of the world, rejoice. California's minimum wage rises to $8 an hour today, up from $7.50 an hour in 2007. California, along with Massachusetts, now has the second highest minimum wage in the country, behind Washington state's, which is $8.07 an hour.

Don't smoke in cars with kids: California is now the third state in the nation to ban smoking in the car with minors. The new law imposes a fine of up to $100 for smoking a pipe, cigar or cigarette in a motor vehicle with another person 17 or younger. The infraction is a secondary offense, meaning you can be fined for it only if you're stopped on suspicion of another, more serious offense. And the fine applies regardless of whether the car is moving.

Cash back for gift cards: California stores now have to give you cash back when you have less than $10 remaining on a gift card. Before, retailers could require you to spend the entire amount at their stores, but this resulted in many consumers simply throwing cards away when only a few dollars remained. It's such a common practice that Best Buy booked $43 million in profits from unspent gift cards in 2006. The new law applies to all gift cards, even those purchased before the law went into effect.

Kangaroo products for sale: California retailers can now legally sell kangaroo leather products, the most popular of which is soccer cleats made from the soft skins. Forty-eight other states allowed their sale before California, which banned it to protect endangered animals, although not all kangaroos are endangered and reports indicate the law hadn't been really enforced for years.

HIV testing becomes routine: California patients are no longer required to fill out a consent form before being tested for HIV. Under the new law, doctors still have to tell patients they would like to add HIV to the list of other conditions they are testing for, but the form has been eliminated. The law has been called the biggest change in AIDS policy since the '80s and is expected to result in earlier detection. Patients can still decline if they don't want to be tested.

Citizenship – don't ask, don't tell: California cities and counties are now forbidden from passing any laws that would require landlords to inquire about the citizenship or immigration status of current or potential tenants. This law was prompted largely by the city of Escondido, which adopted an ordinance that barred landlords from renting to undocumented immigrants. The ordinance was immediately challenged in federal court, which issued a temporary restraining order. The city council rescinded the ordinance a short time later.

Notification when you change parties: State law now requires that when county election officials notify voters in writing that their voter registration information has been updated, the letters must note that the change could be to their party affiliation. Before, the notification letters simply listed the new information, including the new party affiliation, but many voters didn't notice it. A 2006 Orange County Register investigation found that more than 100 unsuspecting voters had their party affiliations changed to Republican without their consent by signature gatherers circulating petitions and voter registration cards.

Here are some of the other laws that take effect with the start of the new year:

Lights, water: Legislation by Assemblyman Jared Huffman, D-San Rafael, gives the California Energy Commission until the end of 2008 to develop tougher efficiency standards for general purpose lights. Other Huffman bills authorize a $250 million subsidy program to encourage installation of solar water heaters and require the Energy Commission to establish water-efficiency standards for the design of new buildings.

Homeless shelters: A new law written by Sen. Gil Cedillo, D-Los Angeles, is intended to remove roadblocks for homeless shelters by requiring cities and counties to designate areas where shelters can be located without obtaining a conditional use permit.

Identification devices: Legislation by Sen. Joe Simitian, D-Palo Alto, prohibits an employer or anyone else from requiring a person to have a radio frequency identification device inserted under the skin. The devices, about the size of a rice grain, can be used to track and transmit personal information about the user.

Flood control: Cities and counties could be forced to cover a share of the damage caused by flooding if they approve new development without considering flood risks, under legislation by Assemblyman Dave Jones, D-Sacramento. A related bill by Sen. Mike Machado, D-Linden, will require cities and counties in the flood-prone Central Valley to follow new flood protection requirements in making land-use decisions.

Gang parenting: Courts could require the parents or guardians of gang members to attend parenting classes under legislation by Assemblyman Tony Mendoza, D-Artesia, that attempts to prevent first-time juvenile offenders from committing additional crimes.

Sperm cleansing: Legislation by Sen. Carole Migden, D-San Francisco, allows sperm from a man with HIV to be used to artificially inseminate a wife or partner who does not have the disease if the woman consents and the sperm is processed to minimize the possibility of infection.

Iran investments: The state's two giant public pension funds, the California ublic Employees' Retirement System and the California State Teachers' Retirement System, will be prohibited from investing in companies that have defense- or nuclear energy-related business with Iran. The bill is by Assemblyman Joel Anderson, R-La Mesa.

Phony music: Assemblyman Anthony Portantino, D-La Canada Flintridge, is the author of a law that attempts to ensure that music fans who buy tickets to oldies concerts are not victims of deceptive advertising. The legislation requires performing groups to meet at least one of several standards to be able to legally use the name from the groups' recording days. An example: The group must include at least one member who has the legal right to use the name. Bands also can avoid lawsuits by acknowledging they are a salute or tribute to the original recording group and had a name that did not confuse ticket buyers.

The Associated Press contributed to this report.

Doctors Seek Cash when Insurance doesn't pay...

2007-11-30T17:39:00.000-08:00

Friday, November 30, 2007
Doctors seek cash when insurance doesn't pay
Some patients opt to stay with provider and pay more out of pocket, while others seek new care.
BY COURTNEY PERKES
The Orange County Register http://www.ocregister.com/news/insurance-gersh-patients-1932629-doctors-office A small but growing number of Orange County doctors has stopped accepting private insurance, saying they are fed up with low reimbursements that can take months to receive, lost claims and denials of necessary medical care.

This fall, Women's Medical Group of Irvine dropped roughly 20 preferred provider organizations after more and more staff time went to insurance paperwork rather than patients.

To read the complete article, please visit the OC Register's website.

"There's so much frustration as far as the wrangling over the claims," said Michele Revelle, executive director of the Orange County Medical Association, which on Thursday held a first-ever conference on how to negotiate insurance contracts. "It's too expensive to chase."
As doctors seek to avoid bureaucratic hassles, their patients can be left with higher costs in some cases or finding a new doctor within their insurance network.

Karen Hochwald, a 45-year-old Irvine homemaker, paid $140 for an October visit to Gersh, a change from her usual $10 co-pay through her Blue Shield PPO. She left with an itemized bill, which she mailed to her insurer. Blue Shield sent her a partial reimbursement within about two weeks.

To read the complete article, please visit the OC Register's website.

Here's an excerpt from a follow-up letter Women's Medical Group of Irvine sent to patients to answer questions about the decision to stop accepting private insurance:

"But how much more is this going to cost me? That's hard to say, since each plan sets its own rates for out-of-network payments. Your best bet is to check your policy or call your insurance company to find out what your specific coverage is. We can, however, offer these guidelines:

"First, during the past five years, deductibles have skyrocketed. It is not unusual to find plans with $250, $500 all the way up to $5,000 annual deductibles. In these cases, you end up paying the full bill, whether we submit the claim or you do. We have kept our charges close to insurance-company reimbursement rates so that your actual out-of-pocket payment for services will be virtually the same.

"Second, some insurance plans reimburse out-of-network providers at close to the same rates as in-network providers. In these cases there may, or may not, be a small additional cost to getting your care at our office. If your co-pay is more than the difference in the reimbursement rate, then it will likely cost you less to come to our office now than it has in the past."

To read the complete article, please visit the OC Register's website.

Contact the writer: 714-796-3686 or cperkes@ocregister.com

Julia

New Enrollment Opportunities for Small Businesses

2007-10-16T16:31:00.000-07:00

Blue Cross of California NEWS FLASH

If your small business is enrolled in one of Blue Cross' Small Business Health Insurance plans, then you need to get a move on!! Blue Cross has a special open enrollment opportunity for Small Groups wanting to move some or all of your employees to any of BC's HSA-Compatible and HIA Plus Plans!

Now is the time for Small Group clients to combine good business and financial strategies with your end of the year Health Insurance decisions.

Why?

Because Blue Cross Life & Health Insurance Company’s Special Small Group Open Window begins December 1, 2007 and ends January 31, 2008 for small businesses that already have a Blue Cross Plan. During this time, any one or all of your currently enrolled employees can move over to any one of these plans:

Lumenos HSA 1500
Lunenos HSA 3000
Lumenos HIA Plus 3000
PPO 2400 (HSA Compatible)
PPO 3500 (HSA Compatible)

These comprehensive health plans offer great benefits such as low premiums and low annual out of pocket maximums ~ as well as the convenient option to set up an HSA (Health Savings Account) through Mellon Bank that works hand-in-hand with the plan. Your employees can fund their HSA with pre-tax dollars – and then use those dollars for qualified medical expenses including prescription drugs.

Remember => for January 1, 2008 effective dates, the IRS has determined that the maximum annual contribution will be $2900 for an individual and $5800 for a family

To enroll your Small Business and/or your currently enrolled Blue Cross employees in an HSA-Compatible or HIA Plus Plan for the New Year, simply email me and I will help you make the change!

julia@crossins.com

CA Lic # 0B28378

HDHP's and HSA's

2007-09-23T09:17:00.000-07:00

Thanks for visiting my Blog!!

The Health Insurance industry is always changing. With insurance companies merging, consolidating, raising rates and reducing benefits it can be difficult to get the coverage you need in times of crisis. With the cost of medical care skyrocketing at an alarming rate, it can be impossible to keep your family financially solvent when you have a medical crisis even if you do have insurance. And, as with all types of insurance, you need to purchase it BEFORE you need it; once you need it, it's too late.

The most common types of Health Insurance plans in America are the traditional plans that everyone is familiar with ~ HMO's and PPO's.

But have you heard of HSA's?

HSA's (Health Savings Account) are a new way of thinking; or better said, HSA's are a new twist on an old concept.

You start by purchasing a Federally approved "High Deductible Health Plan" (HDHP) thru the carrier of your choice such as Blue Cross of California. Once that policy has been approved and issued, you then open an HSA thru one of many Federally approved financial institutions such as Wells Fargo Bank and Chase Bank.

HSA's are designed by the Fed Government to allow you to fund a separate Health Savings Account using Pre-Tax dollars. You then use this HSA to pay for your out of pocket medical expenses throughout the year. A single person can put nearly $3000 per year into your Tax Free HSA. You can choose to fund the account anyway you want....lump sum annually, regular monthly or quarterly deposits etc. At age 65 any money that you have built up in your HSA can be used to pay for long term medical care premiums and costs or to pay for your Medicare Supplement Policy premiums or it can sit there as an inheritance item.

As with all insurance, the higher your deductible is, the lower your premium will be. The idea behind HSA compatible HDHP is that the money you save by paying lower premiums is put into a Tax Free HSA to be used to pay for your out of pocket medical expenses.

Its a Win-Win situation.

You can more find information at the Department of the Treasury's website including answers to frequently asked questions, related IRS forms and publications, technical guidance, and links to other helpful web sites. The Treasury's HSA website can be found through http://www.treas.gov/ (click on "Health Savings Accounts") or directly at the following address http://www.treas.gov/officers/public-affairs/hsa/

For more information, please email me! To quote or apply for your own HDHP/HSA please visit my website at http://www.crossins.com/

Cheers!

Julia Cross
CA Lic # 0B28378