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
(Illustration: Andy Warner)
Since June, KQED has been crowdsourcing health care prices.
For starters, insurers paid from $128 to $694 for a screening mammogram.
Why turn to crowdsourcing? Because health care prices are notoriously opaque. Negotiated rates between insurance companies and providers, both doctors and hospitals, are sealed tight, by contract. We know there’s variation, but comparing what one insurance company pays with another is virtually impossible.
So we asked you, the members of our community, to share what you paid.
Together with our collaborators KPCC in Los Angeles and ClearHealthCosts.com, a New York City startup dedicated to health cost transparency, we created a form to make it easy for people to share what they paid — and easy for consumers to see apples-to-apples comparisons of prices. Continue reading
Kevin Spacey stars as Frank Underwood in the Netflix series “House of Cards.” (Kevin Winter/Getty Images)
The power play behind Proposition 45 could be fodder for an episode of House of Cards:
Dave Jones might not like this comparison, but he’s the Frank Underwood in this fight.
“Power is a lot like real estate. It’s all about location, location, location. The closer you are to the source, the higher your property value,” so goes protagonist Frank Underwood, who plays the menacing House majority whip scheming to get closer to the president.
You’d never think there’d be such positioning over who gets to regulate health insurance.
But this is California. And no less than three state agencies want to have a say in this one. Continue reading
A majority of the state’s voters support extending current health insurance programs to all low-income Californians, including undocumented immigrants, according to a new statewide poll released Monday.
The poll was commissioned by The California Endowment, a foundation that has been actively working to expand health insurance access to all people, regardless of immigration status. The Affordable Care Act expressly bars undocumented immigrants from receiving any of its benefits, including subsidies to purchase health insurance.
In the poll, 54 percent of those surveyed said they support covering the undocumented. Support was strongest among younger voters as well as Latino respondents and African Americans.
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
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
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
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
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.
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.