health insurance

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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

Report: California State Employees Get Relatively Generous Health Insurance

(Getty Images)

(Getty Images)

SACRAMENTO, Calif. (AP) — Health insurance plans offered to state employees in California and elsewhere are relatively generous, with government picking up a large share of deductibles and co-pays, according to a report released Tuesday.

The report by The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation was a first-of-its kind survey of state government health insurance plans nationwide. It found that state plans paid on average 92 percent of a typical enrollee’s health care costs, which is equivalent to the best offerings — “platinum” plans — that the public can purchase on one of the new health insurance exchanges.

In California, Pew found that figure was 95 percent and that 68 percent of plan members had no annual deductible.

Putting the report into a broader context that can make the data easily understood is difficult. Continue reading

On California Exchange, Only Kaiser’s Rates Will Go Down in 2015

Kaiser Permanente's lower rates on the California health exchange for 2015 may be meant to attract customers. (Ted Eytan/Flickr)

Kaiser Permanente’s lower rates on the California health exchange for 2015 may be meant to attract customers. (Ted Eytan/Flickr)

As all the other health insurers on California’s Obamacare exchange raise their rates for next year, Kaiser Permanente plans to lower them.

The Los Angeles Times reports that a new analysis by Citigroup shows Kaiser’s premiums dropping by 1.4 percent in 2015.

At the same time, the average premium across all plans on the Covered California exchange will rise 4.2 percent.

Citigroup health care analyst Carl McDonald told the Times he thinks Kaiser’s move is meant to draw customers: Continue reading

State Reconsiders Letting Catholic Universities Limit Abortion Coverage

Santa Clara University's employee health insurance will stop covering 'elective' abortions next year unless state officials change their minds. (Michael Zimmer/Flickr)

Santa Clara University’s employee health insurance will stop covering ‘elective’ abortions next year unless state officials change their minds. (Michael Zimmer/Flickr)

By Grace Rubenstein and Mina Kim

State officials are reviewing whether they made the right call when they approved health plans that limit abortion coverage.

California law has strongly protected abortion rights for decades. But in recent years, the state’s Department of Managed Health Care — which oversees health insurance — has approved a handful of plans that exclude coverage for “elective” abortions. That is, abortions that aren’t necessary to protect the health of the mother.

Those insurance-plan approvals occurred quietly, with little public attention. Until last year, when officials at two Catholic universities, Santa Clara University and Loyola Marymount in Los Angeles, told faculty and staff that the schools would now only cover abortions that are “medically necessary” for the mother’s health. State officials had approved those insurance plans.

The decision surprised and angered hundreds of Santa Clara faculty members, who tried and failed earlier this year to get the school’s Board of Trustees to reverse the decision. And it also appeared to reverse decades of legal precedent in California. Now, officials from the Department of Managed Health Care say they’re going back and reviewing the policy.
Continue reading

Explaining the Health Insurance ‘Explanation of Benefits’

By Lynne Shallcross

We are wrapping up the first phase of our PriceCheck project. The goal is to shine a light on costs of common health care procedures in California. We’re starting with screening mammograms, and already we’ve found that the cash price (for people who are uninsured or have gone out of network) varies from a low of $60 at the H. Claude Hudson Comprehensive Health Center in Los Angeles, a county-run clinic, to $801 at U.C. San Francisco on the high end.

Together with KPCC in Los Angeles and ClearHealthCosts.com, we’re also asking you, the members of our community, to share what you’ve been charged — and what your provider has been paid — for common health procedures.

In order to do that, you need to get familiar with your insurance company’s “explanation of benefits” or EOB. That’s the form your insurer sends to explain what was paid, to whom, at what level and why.

Here’s a typical EOB, that we’ve marked with some explanations below:

An explanation of benefits from Anthem Blue Cross.

An explanation of benefits from Anthem Blue Cross.

Continue reading

Covered California Questions Health Insurance Initiative

Covered California executive director Peter Lee, seen here at a November, 2013, press conference. (Max Whittaker/Getty Images)

Covered California executive director Peter Lee, seen here at a November, 2013, press conference. (Max Whittaker/Getty Images)

UPDATE: June 20

KQED’s April Dembosky attended the Covered California board meeting Thursday afternoon where the board expressed concern that a voter initiative on the upcoming November ballot could compromise its authority. The initiative would give the state’s insurance commissioner the authority to reject excessive rate increases in health insurance premiums.  But Covered California already negotiates rates with insurance plans. How would the initiative, if passed, affect Covered California?

Covered California board member Susan Kennedy called on agency staff to conduct an intensive analysis of the initiative’s potential impact Covered California’s ability to operate — and to get it done soon.
Continue reading

Insurance Commissioner Defends Health Insurance Initiative

Dave Jones leads the California Department of Insurance. (Courtesy: Department of Insurance)

Dave Jones leads the California Department of Insurance. (Courtesy: Department of Insurance)

In this lull between the end of the first open enrollment for Covered California and the release of rates for next year — expected to be made public in July — San Francisco’s Commonwealth Club invited the state’s Commissioner of Insurance Dave Jones to talk about the state of the health care overhaul in California.

The commissioner closed his remarks by pitching for the rate review ballot initiative coming up in November. As moderator of the discussion following, I fielded several questions from the audience about the upcoming initiative. To recap the basics: If passed, the initiative would give the insurance commissioner the authority to reject excessive health insurance rate increases.

The insurance commissioner already has that authority over auto, homeowner, property and casualty insurance — via voter-passed Proposition 103 back in 1988. Many voters are surprised, Jones said, to find out he cannot also reject health insurance premium increases.  He called this lack of explicit authority a “major missing piece of the Affordable Care Act.” Continue reading

Why Are Nearly All Covered California Enrollees in Just Four Plans?

Certified specialist helps a consumer apply to Covered California at a free enrollment fair at Pasadena City College. (David McNew/Getty Images)

Certified specialist helps a consumer apply to Covered California at a free enrollment fair at Pasadena City College in November. (David McNew/Getty Images)

By Dan Diamond, California Healthline

Anthem Blue Cross had 1,591 people use Covered California to get subsidies and sign up for its health plans in October.

Valley Health Plan had five.

That data point’s taken from a Covered California release that offers some of the first insight into the makeup of early enrollees through the exchange and which plans they’re picking. And while it’s hardly fair to directly compare the two issuers — Anthem has a presence in all 19 of Covered California’s regions, whereas Valley is only offering plans in Santa Clara County — the contrast is eye-catching.

It’s also telling. The biggest players, so far, are getting enormous market share from Covered California’s customers. The smaller plans are seeing a trickle.

So Far, Exchange Strengthens Market Position of Large Plans Continue reading