As part of a deal with California regulators, the state’s largest health insurer will offer new coverage to 2,330 people it dropped after they submitted bills for expensive medical care.
By Lisa Girion
February 11, 2009
Anthem Blue Cross, the state’s largest for-profit health insurer, has agreed to pay a $1-million fine and offer new coverage — no questions asked — to 2,330 people it dropped after they submitted bills for expensive medical care.

As part of a deal that the California Department of Insurance is set to announce today, Anthem also will offer to reimburse those people for medical expenses that they paid out of pocket after they were dropped. The company, a subsidiary of Indianapolis-based WellPoint Inc., estimated that those reimbursements could reach $14 million.

In exchange, the state agreed to drop its prosecution of its accusation that the company broke state laws in the way it rescinded members in preferred provider organization (PPO) policies between 2004 and 2008.

The settlement follows Anthem’s agreement last year to pay a $10-million fine to settle similar charges involving 1,770 members in HMO-type policies overseen by the Department of Managed Health Care, another state regulator.

In both cases, Anthem agreed to make substantial changes in the way it sells and manages individual insurance coverage in California. Those changes, which include simplifying coverage applications, are expected to reduce the number of people who lose coverage through rescission.

The Anthem deal is the latest in a two-year effort by regulators to crack down on health insurers for dropping sick members on dubious grounds. It brings the last state rescission investigation to a close.

But insurers Anthem, Blue Shield of California and Health Net Inc. all remain targets of individual and class-action lawsuits alleging that they gamed insurance laws to dump sick people and avoid the costs of their care.

The only case to go to trial so far involved Health Net’s rescission of a woman suffering from breast cancer. In that case, an arbitration judge awarded $9 million to Patsy Bates, a Gardena hair salon owner, after hearing her recount the fear she felt when she lost insurance and had to stop chemotherapy treatments.

“I am pleased that through this settlement, we have guaranteed reimbursement and restoration of coverage for the more than 2,300 people whose healthcare insurance was terminated without their consent,” state Insurance Commissioner Steve Poizner said about the Anthem deal. “The settlement is a significant step towards ending rescission practices that can devastate consumers already weakened in their battle against illness.”

Leslie A. Margolin, president of Anthem Blue Cross Life, the unit involved in the deal, said she too was pleased.

Margolin said the company would be contacting consumers over the course of the next 90 days and sending them information on how to participate in this settlement.

“Under the terms of the settlement, Anthem Blue Cross Life will invite these consumers to purchase coverage on a go-forward basis, regardless of past or present medical conditions,” she said. “Additionally, these consumers will be eligible to receive reimbursement of prior out-of-pocket medical expenses.”

Under the deals with regulators, rescinded patients can accept new coverage without forfeiting any legal rights. But they must waive their right to sue insurers in order to make claims for out-of-pocket medical expenses.

Critics say medical expenses often are only the beginning of the losses. In some cases, they say, patients were unable to get care because they couldn’t pay for it, causing health conditions to worsen. In others, mounting medical bills damaged their credit and led to financial calamity.

Then there are the less tangible consequences. Bates, for instance, was awarded about $700,000 for pain and suffering.

“You have to give everything else up just to get your medical bills paid,” said William Shernoff, Bates’ lawyer. “I’m all for getting medical bills paid, but this is coercive. That’s the real bad part of this settlement and the other ones too.”

Jerry Flanagan, a patient advocate with Consumer Watchdog in Santa Monica, said Anthem’s $1-million fine was “an insult to the people of California, especially those who have lived under the financial destruction caused by rescission.”

The fine, he said, pales in comparison to what Anthem must have saved by rescinding policies for years. Anthem has never said what costs it avoided through rescission. But Health Net, in documents produced for the Bates trial, said it avoided $35.5 million by canceling 1,600 policies.

“A low fine encourages the company to rescind more policies because the company saves far more money on the policies it does not get caught rescinding,” Flanagan said.

Darrel Ng, a spokesman for Poizner, said the commissioner’s top priorities were winning back coverage and medical reimbursements for rescinded patients. Another goal was to close the door on improper rescissions by persuading Anthem to agree to changes in the way it does business and the threshold it uses for dropping coverage.

The fine was a lower priority than the 2,330 people affected, Ng said. “In our mind it was more important to take care of these people who had their insurance policies canceled than to continue negotiating for something that wouldn’t directly help these people.”

Categories: Blue cross blue shield ppo providers
Tags: anthem ppo, blue cross ppo

Aetna Insurance was created in 1850 and submitted itself into the pool of different health insurance coverage in the early 1900’s. They are best known for their variety of different types of health insurance plans they have all different plans that range from plans that are similar to HMO’s to plans that are similar to PPO’s. One question that many people ask when trying to figure out what health insurance plan to use is what is the difference between a HMO and PPO?

First let’s talk about what they mean, a HMO stands for health maintenance organization, and PPO stands for preferred provider organization, they both are different in a few ways and you really have to look into them and the type of Aetna family health insurance plan you have in order to choose what is right for you and your family.

They both have many benefits so choosing the right one will take research and time but make sure you put that time in to figure out what would be the best for you. With an HMO plan people have to choose a doctor who is a HMO member physician, this physician will be in charge of all of your medical needs and will have to write you referrals for any type of additional medical attention you may need such as going to see a dermatologist, these specialists who you will go will have to be part of the HMO as well.

A referral is similar to a short letter or even a short sentence that your HMO physician will send to the specialist in order to give them permission to treat you. One of the benefits of having a HMO is they only provide coverage when you are being treated by a HMO physician, if isn’t you normally have to pay on your own for the visit. There are special circumstances where people have been allowed to see other doctors but this is normally during emergency circumstances where another doctor cannot be reached. One of the best things about HMO’s and especially when using Aetna family health insurance is that there is no individual deductible to reach each month or year, there is just a very low co-payment that you have to pay each time you go to the doctors office.

Now lets talk about a PPO, a PPO allows you to see a specialist or a physician without a referral, they do not have to stay within only PPO providers but many people do because they are normally reimbursed for the money they may spend on the appointment. This is the best type of plan to have when you are very set on the type of doctor you want, or if you know a doctor very well. One of the great benefits of having a PPO is that you are reimbursed at least 40-50% if you see doctors outside your PPO coverage, which means no matter what doctor you see you will be gaining some type of money back.

Ronnie Hamilton shares his knowledge on health insurance that makes you able to find the plans that best fits your needs.If you want to know about Affordable health insurance,Aetna family health insurance,Texas health insurance plans visit www.usa-healthinsurance.com

Categories: Aetna PPO Insurance
Tags: aetna hmo, Aetna PPO Insurance

Some dental insurers are changing the way they pay dental benefit claims, creating confusion and erecting barriers to care for thousands of Hoosiers.

The issue, called assignment of benefits, traditionally has worked well for dentists and patients. Through a signature on their insurance forms, patients request insurance companies send payment for their treatment directly to the doctor, who then bills the patient for any remaining balance. This arrangement customarily has allowed dental providers to float the cost of a patient’s treatment until insurance payments arrive, which can take weeks or even months.

Now, some dental insurers have decided not to honor patients’ wishes if the doctor does not belong to the insurance company’s preferred provider organization, or PPO. Instead, as a means of pressuring doctors to join their networks, some insurers are sending benefits to the patient’s home, knowing that these payments may never reach the dentist.

For patients not expecting an insurance check, it’s confusing when it arrives in the mail. Thinking it’s a refund check, they may cash it and not realize the dental bill is outstanding. For those who do forward the check to their dentist, it’s just another hassle they don’t need.

Dentists are small-business owners with staff salaries and overhead. If dentists are unsure that insurance companies will cover their claims, they may need to ask patients to pay up front for treatment, which causes hardships for many and presents a barrier to care. The Indiana Dental Association believes insurance companies should stop meddling in the relationship between patients and their dentists.

Two bills currently before the Indiana General Assembly, SB 75, sponsored by Sen. Beverly Gard, R-Greenfield, and HB 1299, sponsored by Rep. Peggy Welch, D-Bloomington, would protect patients’ rights to decide who receives their insurance benefits.

We invite the public to contact lawmakers to support SB 75 and HB 1299 and join more than 40,000 Hoosiers who have signed our petition, both in dental offices across the state and online at www.supportpatientrights.com.

Categories: Dental PPO Insurance
Tags: indiana ppo insurance, ppo dental insurance, ppo dental plans, ppo insurance

The idea of a is preferred provider organization that the providers will provide the insured members of the group a substantial discount below their regularly-charged rates. This will be mutually beneficial in theory, as the insurer will be billed at a reduced rate when its insured utilize the services of the “preferred” provider and the provider will see an increase in its business as almost all insureds in the organization will use only providers who are members. Even the insured should benefit, as lower costs to the insurer should result in lower rates of increase in premiums. Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network. They negotiate with providers to set fee schedules, and handle disputes between insurers and providers. PPOs can also contract with one another to strengthen their position in certain geographic areas without forming new relationships directly with providers.

What is a Health Savings Account (“HSA”)?

A Health Savings Account is an alternative to traditional health insurance; it is a savings product that offers a different way for consumers to pay for their health care. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.

You must be covered by a High Deductible Health Plan (HDHP) to be able to take advantage of HSAs. An HDHP generally costs less than what traditional health care coverage costs, so the money that you save on insurance can therefore be put into the Health Savings Account.

You own and you control the money in your HSA. Decisions on how to spend the money are made by you without relying on a third party or a health insurer. You will also decide what types of investments to make with the money in the account in order to make it grow.

What Is a “High Deductible Health Plan” (HDHP)?

You must have an HDHP if you want to open an HSA. Sometimes referred to as a “catastrophic” health insurance plan, an HDHP is an inexpensive health insurance plan that generally doesn’t pay for the first several thousand dollars of health care expenses (i.e., your “deductible”) but will generally cover you after that. Of course, your HSA is available to help you pay for the expenses your plan does not cover.

For 2008, in order to qualify to open an HSA, your HDHP minimum deductible must be at least $1,100 (self-only coverage) or $2,200 (family coverage). The annual out-of-pocket (including deductibles and co-pays) for 2008 cannot exceed $5,600 (self-only coverage) or $11,200 (family coverage). HDHPs can have first dollar coverage (no deductible) for preventive care and apply higher out-of-pocket limits (and copays & coinsurance) for non-network services.

How can I get a Health Savings Account?

Consumers can sign up for HSAs with banks credit unions, insurance companies and other approved companies. Your employer may also set up a plan for employees as well.

How much does an HSA cost?

An HSA is not something you purchase; it’s a savings account into which you can deposit money on a tax-preferred basis. The only product you purchase with an HSA is a High Deductible Health Plan, an inexpensive plan that will cover you should your medical expenses exceed the funds you have in your HSA. However, HSA trustees often will charge fees for their services.

What is Short Term Health/Medical Insurance?

Short Term Health Insurance Defined:
Short term health insurance is health insurance coverage issued for a relatively short period of time. When you buy this type of policy, you can choose a period of coverage that may be as short as 30 days, or as long as 365 days (depending on state). Several deductible and coinsurance options are available, with the premium cost varying according to what features you choose. You customize your health insurance to meet your needs. Best of all, temporary plan coverage begins immediately!  Apply today and your coverage will begin as soon as tomorrow.  Short term health insurance is also referred to as short term medical insurance, temporary health insurance, temporary medical insurance or interim health / medical insurance.

What is Covered Under a Typical Short Term Health Plan:
Short term health insurance typically covers the same things as conventional, “permanent” major health insurance such as prescription drugs, hospitalization, emergency room, doctors’ services in hospital and in office etc. It does not cover dental care or optical care (except as it pertains to an accident or illness), normal pregnancy or childbirth, well childcare, sports injuries, pre-existing conditions, or care received outside the USA.

Who Can Use Short Term Health Insurance:
If you’re between jobs, a recent college graduate, or waiting on a new health plan to take effect, customized short term health insurance can provide you and your family with the security you need.  If you’re not sure if short term health insurance is right for you, here are a list of typical situations.

Who Can Use Short Term Health Coverage?

Does your health insurance need match any of the profiles below?

Are you…..

· Looking for an Affordable Alternative to COBRA?
Individuals not wishing to pay for expensive COBRA insurance can benefit from a less expensive customized health insurance plan.

· Working Freelance, Part-time or Contract Positions while Looking?
A temporary health plan is often a good option for freelance, part-time or contract workers looking for major medical coverage.

· No longer Eligible for Your Parents Insurance Plan?
Young adults no longer covered by their parents’ plan can often find affordable (and immediate) insurance coverage through a customized short term medical plan.

· Unemployed, Laid Off or Between Jobs?
If you’re unemployed or between jobs, short term health insurance is an affordable way to get immediate insurance coverage for you and your family?

· A College Graduate or Soon to Graduate?
Customized short term health insurance plans are ideal for college graduates because they’re affordable, offer immediate coverage and give you the piece of mind of insurance coverage while you job search and qualify for an employer-sponsored group insurance plan.

· Waiting for Employer-Sponsored Insurance Through Your New Job?
A short term health Insurance policy is a perfect way to affordably fill the gap between now and when your employer-sponsored plan takes effect.  Can you afford to go uninsured?

· Close to Being Eligible for Medicare?
If you’re within 6-12 months of becoming eligible for Medicare, short term health Insurance may be more affordable than your existing insurance plan.  Learn more here…

· Self-Employed or A Small Business Owner Looking to Save on Health Insurance?
Self-employed professionals and small business owners can save money by using temporary health insurance. A couple of ways are described.

· A Business Manager or Owner who uses Contract Associates?
This is a challenging situation because group insurance requires the employer-employee relationship. But short term medical insurance can be the solution.

· Looking for an Affordable Child-only Health Insurance Plan?
A child-only temporary health plan is often a good option for parents looking for major medical coverage only for their children. http://www.USQuoteHunter.com

Categories: PPO Coverage
Tags: ppo coverage, ppo insurance companies, ppo insurance plans, ppo insurance rates, preferred provider organizations

As the health insurance market increasingly becomes consumer-driven, BlueCross BlueShield of South Carolina is seeking to serve people shopping for insurance with face-to-face assistance at the company’s first retail outlet scheduled for a grand opening Jan. 23 in Mount Pleasant, S.C.

Located at 615 Johnnie Dodds Blvd., Suite 102, in The Plaza at East Cooper Shopping Center, the 1,800 square foot SC BlueStore(SM) will open officially with a ribbon cutting ceremony at 10:30 a.m., Jan. 23. The event will feature comments by BlueCross executives and will be attended by representatives from the Mount Pleasant city council, the Charleston Metro Chamber of Commerce, and other dignitaries.

BlueCross will offer insurance for individuals, both under age 65 and over age 65, as well as children’s policies at the store. Shoppers also may attend wellness seminars to be scheduled periodically and use a wellness station where they can check blood pressure, experience a chair massage and enjoy refreshments.

“Our SC BlueStore is designed to provide a comfortable and informative space for a customer to discuss insurance,” said BlueCross BlueShield Division President David Pankau. “Cutting through the confusing world of insurance terminology, we plan to provide clear and concise information to help them select the health insurance plan that is right for them. This will be a much more satisfying personal experience in a convenient retail setting.”

The store, to be staffed by BlueCross personnel and independent agents, will be open 9:30 a.m. - 6:30 p.m. Tuesdays through Fridays and 8:30 a.m. - 4:30 p.m. Saturdays.

BlueCross offers health insurance for children, adult individuals, families, senior citizens and employer groups. The company recently introduced Blue Spectrum(SM), a rebranding of the company’s health insurance plans that also adds new, lower cost plans. All BlueCross members benefit from BlueCross’ preferred provider (PPO) network, the largest in the state, and the BlueCard(R) network that allows in-network access to providers in other states served by other Blue Cross and Blue Shield companies.

Headquartered in Columbia, S.C., BlueCross BlueShield of South Carolina (www.SouthCarolinaBlues.com) is an independent licensee of the Blue Cross and Blue Shield Association. BlueCross BlueShield of South Carolina and its family of companies include more than 20 subsidiaries involved in health insurance services, U.S. DoD health plan and Medicare contracts, and other insurance and employee benefits services.

Categories: PPO Coverage
Tags: blue cross blue shiled