Anthem Blue Cross

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Covered California Patients Not Only Ones with Network Woes

(Getty Images)

(Getty Images)

Charlie Spiegel said he was “thrilled” when he learned that the Department of Managed Health Care was taking action against two major insurers that sell policies on the Covered California marketplace. The companies, DMHC says, had violated state law by listing doctors on their online directories who were not part of their network.

Spiegel, of San Francisco, is not a Covered California policy-holder, but he’s having significant problems of his own with the individual policy he bought from Anthem Blue Cross earlier this year.

Here’s the background: Spiegel, 56, says he enjoys good health, but had been postponing various preventive tests due to cost. Before the Affordable Care Act went into effect, he had a high deductible plan. Continue reading

Stanford Terminates Anthem’s Contract; Anthem Uses KQED Data to Cite Stanford’s Cost

The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images)

The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images)

Effective Monday at 12:01a.m., Stanford Health Care terminated its contract with Anthem Blue Cross. Anthem says that roughly 10,000 of its policyholders have used Stanford services in the last year.

In a statement, Anthem said it had requested that “Stanford agree to a two-week extension of the terminated contract at existing rates.” Both parties say negotiations are ongoing.

Stanford had notified the insurer on Feb. 28, Anthem says, that it intended to terminate the contract.

The sticking point appears to be the duration of the contract. Both sides say that they reached agreement on rates for a two-year contract, but Stanford seeks a three-year contract. Because no agreement has been reached on the third year, and because Stanford did not extend its current contract, no contract is in force. Continue reading

Stanford Health Care Terminates Anthem Blue Cross Contract

As many as 10,000 patients may be affected by Stanford Health Care's termination of its contract with Anthem Blue Cross. (Robert Skolmen/Wikimedia Commons)

As many as 10,000 patients may be affected by Stanford Health Care’s termination of its contract with Anthem Blue Cross. (Robert Skolmen/Wikimedia Commons)

Stanford Hospital and Clinics — now known as Stanford Health Care — is ending its contract with Anthem Blue Cross effective Sunday night at midnight. The move could affect 10,000 patients.

According to both Stanford and Anthem spokespersons the two sides had reached agreement on a two-year contract. But Stanford seeks a third year; Anthem does not. The two parties could not come to terms as of Friday, so there is no new contract.

Stanford said the current contract ends Sunday, and since they do not have a deal for a new contract, they opted to terminate.

But, Anthem sees the termination of the contract as unnecessary. “Nothing compels (Stanford) to terminate on Sunday night,” said Anthem spokesman Darrel Ng. Continue reading

‘Narrow Networks’ Frustrate Consumers in California and Nationwide

(Helen K/Flickr)

(Helen K/Flickr)

By Julie Appleby, Kaiser Health News

Marcia Perez of Palo Alto may live 2,000 miles Nancy Pippenger in Indiana, but the two women have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers.

“To try to find a doctor, I’m very limited. There aren’t a lot of names that pop up.”

“They said, ‘We take the old plan, but not the new one,’” says Perez, who is an attorney in Palo Alto.

In Plymouth, Ind., Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him.

Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but they’ve triggered a backlash as millions across the country start to use the coverage they signed up for this year through the new federal and state marketplaces. The policies’ limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect. Continue reading

Anthem Blue Cross Sued Over Covered California Doctor Networks

The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images)

The Anthem Blue Cross headquarters in Woodland Hills, California. (David McNew/Getty Images)

By Julie Appleby, Kaiser Health News

Statewide insurance giant Anthem Blue Cross misled “millions of enrollees” about whether their doctors and hospitals were participating in its new plans, and failed to disclose that many policies wouldn’t cover care outside its approved network, according to a class action lawsuit filed Tuesday.

As a result, many consumers are on the hook for thousands in medical bills, advocacy group says.

As a result, many consumers have been left on the hook for thousands of dollars in medical bills, and have been unable to see their longtime doctors, alleges the suit by Consumer Watchdog based in Santa Monica.

Anthem spokesman Darrel Ng declined to comment directly on the lawsuit. He said Anthem has agreed to pay the claims of those who received treatment from inaccurately listed doctors during the first three months of the year.

However, that policy would not be extended for enrollees who discovered after March 31 that their doctors had been incorrectly listed, he said. Continue reading

People With Canceled Health Insurance Policies Shifted to New Ones Without Permission

The Anthem Blue Cross headquarters in Woodland Hills. Kevin Kingma says the insurer rolled him into a new plan and deducted money from his bank account without his approval, a problem hundreds of consumers say they're having. (David McNew/Getty Images)

The Anthem Blue Cross headquarters in Woodland Hills. Kevin Kingma says the insurer rolled him into a new plan and deducted money from his bank account without his approval, a problem hundreds of consumers say they’re having. (David McNew/Getty Images)

By Charlie Ornstein, ProPublica

When Kevin Kingma received a letter last fall notifying him that his high-deductible health plan was being canceled because of the Affordable Care Act, he visited Covered California, the state’s health insurance marketplace and chose another plan beginning Jan. 1.

Thanks to a subsidy, Kingma’s monthly premium went down, from about $300 to $175, and his benefits improved.

But this month, Kingma, of the Bay Area city of El Cerrito, logged into his bank’s website and saw that his old insurer, Anthem Blue Cross, had deducted $587.40 from his account and had enrolled him in another of its insurance products for this year — he says without permission.

Hundreds of other consumers are caught in the same predicament, insurers acknowledge. And the California Department of Insurance said it is exploring whether any laws were broken when insurance companies withdrew money from consumers’ accounts for plans they didn’t select. Continue reading

Many Walgreens Customers Need to Find New Pharmacy

By Sarah Varney

(Ryan Ozawa: Flickr)

(Ryan Ozawa: Flickr)

As of January 1, Californians who go to Walgreens to get their prescriptions filled may have been in for a surprise. Because of a contract dispute between Walgreens, the nation’s largest drugstore chain, and the company that manages prescriptions for Anthem Blue Cross health insurance, many customers will have to find a new pharmacy.

To find out if you’re affected by the dispute, you should check the back of your insurance card. If it says “Express Scripts,” you can no longer fill your prescription at Walgreens under your insurance plan. Express Scripts is a pharmacy benefit manager or PBM. PBMs negotiate prices for drugs and oversee prescription drug programs for health insurance companies, governments, unions and others.

Continue reading