The advocacy group Consumer Watchdog has filed a statewide class action lawsuit against Anthem Blue Cross saying the health insurer is discriminating against HIV/AIDS patients.
Anthem is changing its pharmacy program and will require anyone using drugs from a list of “specialty” medications to use a mail-order pharmacy, approved by Anthem. But patients seeking to fill other prescriptions may still use their local bricks-and-mortar pharmacy. “That’s exactly the kind of targeting and discrimination barred under the Civil Rights Act in California,” Consumer Watchdog attorney Jerry Flanagan says.
In a statement, Anthem denies the change is discriminatory, because the list of specialty medications includes not only HIV/AIDS drugs, but also medicines for other conditions, such as cancer and multiple sclerosis. Anthem says that the practice is already established. From Anthem’s statement:
“For many years, health plans in California and other states have sought, subject to certain exceptions, that specialty drugs be filled by Specialty Pharmacies and received via confidential home or other private delivery location that benefits the member. … This is being done with the knowledge of our regulator and applies to several hundred different drugs for many medical ailments. Anthem’s policies do not discriminate on the basis of disease states, and they are reasonable and compliant with applicable laws.”
Marta Green at the Department of Managed Health Care confirmed that there are three similar programs already in place in California from Health Net, Sharp and United Health Care of California. Green declined to comment on Consumer Watchdog’s lawsuit, saying the Department had just received it.
State Insurance Commissioner Dave Jones says Anthem Blue Cross’s rate hike on small business plans is “unreasonable” … but he’s powerless to stop it. .
Jones says his department actuaries calculated Anthem’s average 11 percent rate hike on small employers would grow to nearly twenty percent in two years. On a call with reporters Tuesday, Jones blasted the insurer for overstating health care costs and for charging policy holders fees that won’t be collected until 2014 under the Affordable Care Act.
“If you look at, on a return-on-equity basis,” Jones said, “the profits that Anthem Blue Cross of California has made, they have been extraordinary.”
Anthem Blue Cross spokesman Darrel Ng disputes Jones’s figures saying the average rate increase is about half what Jones projects and that Anthem’s profits last year, were about one percent. Continue reading →
The ballot initiative would grant California's Insurance Commissioner the authority to reject health insurance rate increases. (Photo: Thinkstock)
In more than 30 states, government insurance departments have the authority to reject what they determine to be excessive rate hikes for health insurance. But not in California. Earlier this month, consumer advocates launched a drive to put an initiative on the November ballot to let voters decide if California’s Insurance Commissioner should have this power.
“Right now, my sole authority over rates, if I find a rate to be unreasonable, is to sentence a health insurer to my website,” joked Dave Jones, California’s Insurance Commissioner, in an interview.
That’s a bit of an overstatement, as his department does review rates, making sure the math is right and ensuring there are no inaccuracies. Still, what the Department is left with is “whatever element of the bully pulpit we have to try to rein those rates in,” Jones says. Continue reading →
From CommonHealth in Boston comes this nifty and amusing five minute cartoon that explains the Accountable Care Organization — at least from the patient perspective. How is an ACO different from an HMO? And what does it mean for your health? (If you’re not familiar with xtranormal, get ready for computer generated voices.)
What’s significant here is that Blue Shield says it’s spending 85 percent of your dollar on medical care. This is right in line with a requirement of health care reform which has already gone into effect, the “medical loss ratio.” The MLR requires large employer plans to spend 85 percent of revenue on patient care. If they spend less, they must issue a refund to members. Blue Shield also has capped its income (i.e. profit) at two percent. It has pledged to return any income above two percent to its members.