California Health Care

by John Hansen

Many insured in California have complained about billing issues with their health insurance. When it comes to billing, Anthem Blue Cross is one of the best. However, Blue Shield of California and Kaiser Permanente have struggled to keep consumers and agents happy with their billing departments.

California agents say, “Anthem stays on top of things.” Brokers get pending cancellation notices from Anthem Blue Cross by email two times a month. These agents say that the notices are accurate and helpful. Anthem does their billing in-house, and has streamlined procedures to keep their billing department running well.

Blue Shield of California, on the other hand, has a third party (a middle man) do their billing and it has caused lots of problems. Agents complain that reports often are not accurate.

Often Blue Shield broker reports are not up-to-date or are delayed in being sent out. Agents find that when they call on late pay clients, often their clients have already paid, and...

by John Hansen

Anthem Blue Cross and Blue Shield of California are leading the way when it comes to transparency regarding the cost of various health care procedures. They are now providing online tools where consumers can look up various health care procedures, see average costs, and view mortality rates. This helps California consumers in two primary ways.

When your doctor or surgeon tells you a procedure is going to cost X amount of dollars, you can respond intelligently. You’ll know whether or not your medical provider is offering you a reasonable price.

In the past, health plan members often took their physician’s word for it, not having any way to know whether or not the price was affordable. Now, consumers can check average costs ahead of time. They can haggle for a better price, or they can vote with their feet and go find someone who will give them an affordable price.

Mortality rates are worth checking. If you have a 15% chance of dying on the operating table, that may make...

by John Hansen

California health insurance carriers are concerned about acquiring higher risk members who enroll after Open Enrollment is over. Outside of Open Enrollment, some consumers may apply during the Special Enrollment Period (SEP). However, these applicants are required to have a qualifying life event.

Life events include having a baby, losing coverage, moving to California, getting married and more. Many Californian’s have legitimate life events that qualify them to enroll outside of California’s Open Enrollment.

However, there is a growing concern that individuals who do not have legitimate life events are enrolling during SEP in order to avoid having to pay for high cost medical care. Carriers like Anthem Blue Cross and Blue Shield of California have noticed a 40% increase in utilization for new members who sign up during the Special Enrollment Period.

So it seems that adverse selection is not an unfounded fear, but a very real concern. Utilization spikes in the first 3 mon...

by John Hansen

Covered California has mandated that all carriers assign Primary Care Physicians (PCP’s) to all their members. Many expected PPO’s like Blue Shield of California to balk at this. However, top leaders at Blue Shield agree that this move is in everyone’s best interest.

Of the 1.6 million insured in the Covered California Exchange, a huge amount of these new members are not going to the doctor. They’re not getting their checkups, and they’re not getting their free preventative tests.

The whole point of free preventative care made available on Obamacare California plans was to increase the health of the population. However, if enrollees are not availing themselves to these services, the free preventative care is all for naught. Ultimately, the only way to make health care more affordable in California is to get people healthier. Otherwise, costs will just continue to rise.

Toward that goal of getting California healthy, state legislators and health care experts know t...

by John Hansen

Leading experts in the California health insurance market including Jeff Smith, Vice President of Individual and Family Plans for Blue Shield of California, are predicting 2017 rate increases to be in the double digits. Rate increases will affect Obamacare California coverage through the Covered California Exchange as well as medical plans purchased direct through health insurance carriers like Anthem Blue Cross, Blue Shield and Kaiser Permanente.

In California, rate increases as of yet have been considerably modest. In year one of the Affordable Care Act (ACA), the golden state experienced increases in premiums of around 8%. In year two of Health Care Reform, California health insurance rates went up around 4-6 %.

In other states, health insurance rates went up quite a bit more. 27 states in the US had rate hikes of over 12%. 20 states had rate increases of 20% or more. The top drivers of cost increases include:

In patient-care has continued to be a big factor lending to r...

by John Hansen

On May 3-4, 2016, Blue Shield leadership including two vice presidents met with 25 of California’s top agents to thank them for their sales, share industry insights and to receive input. The meetings consisted of a Tuesday night meet and greet and Wednesday morning brainstorm session. On Wednesday morning, the dialogue went on for over four hours.

Blue Shield of California has prided itself in not only being a non-profit health insurance carrier, but also in being “broker-friendly”. Brokers were very happy about Blue Shield products, networks, agent support and commissions.

In 2016, Blue Shield will pay out commissions to agents in the amount of $90 million. Plus, they will pay out $8 million in bonuses. Top leaders at Blue Shield say, “We’re in!” when it comes to supporting brokers.

The chief concern brokers brought up was related to billing problems. Agents said they often followed up with customers who were listed by Blue Shield as non-pays and found that th...

by John Hansen

The Covered California website and the Obamacare California Exchange has taken great measures to insure the security of Personally Identifiable Information (PII). This legally protected information is available to agents, navigators, counselors and health insurance carriers. The Obamacare California Exchange is aware that PII must be kept secure.

One of the online safety measures involves requiring secure emailing. This has been implemented and required for the online transmission of PII. Covered California agents, navigators, assistants, representatives, and Health insurance carriers have all been required to use secure emails when transmitting PII.

When you receive a secure email, often the email comes with an attachment. When you click on the attachment, it opens a web page that requires you to log in. Thus you need not only to have access to your email account, but also to have an additional user ID and password to sign in to view your secure emails.

This creates multi-f...

by John Hansen

Covered California is making strides on their website to increase security. Security breaches have been in the news. This has been an issue in California as well as on the national and international stage.

In an effort to improve security, the Covered California website is now getting cell phone numbers and distributing one time passcodes. This allows the California exchange / Obamacare website to use multi-factor authentication for added safety online.

A typical login page is single-factor authentication. On one computer you enter a login and password. It’s much easier to hack into a database that only uses single-factor authentication.

Now that the Covered California database includes cell phone numbers for agents, they can use multi-factor authentication. They will still require user ID’s and passwords, but they can also send passcodes to email addresses or to cell phones.

Many banks are doing this already. If you log into your bank from a computer or an IP address th...

by John Hansen

So, what do you think of Kaiser Permanente? The answer to that question will often determine whether you want to choose an HMO or a PPO. For many, once that choice has been made, they know what carrier they’re going with.

If your response is, “I’d rather die than sign up with Kaiser,” then likely you’ll want to go with one of the Blues. There are HMO people and there are PPO people. In California, Kaiser Permanente dominates the HMO market, and Blue Shield of California and Anthem Blue Cross dominate the PPO market.

Together, Kaiser Permanente, Blue Shield of California and Anthem Blue Cross took 78% of market share during the 2016 Open Enrollment. So, there are some other options*, but the majority of California went with one of these three.

Some remember all the horror stories of the early days of Kaiser Permanente and the HMO’s. 20-25 years ago some Californians made a decision that they hated HMO’s, and they decided that they would never go back to the �...

by John Hansen

Efficiency is what Kaiser Permanente is great at, and it’s paying off financially. Likely, California’s leading HMO will use this surplus to streamline more, give members a better experience and improve health outcomes. However, due to its inability to take on too many new members, Kaiser Permanente is not expected to lower its rates.

Systems can be updated. Facilities can be improved. Medical staff can receive additional training. New advancements in medicine can be implemented. Kaiser Permanente has led the way in California in all these areas, and they will continue to do so.

Also, Kaiser Permanente will continue to expand their network. Gradually over time, new KP facilities will pop around California.  Kaiser is expected to expand in two main ways:

Will Kaiser be growing into more rural, less populated areas? Maybe, but definitely not right away. The Kaiser system does best in areas with larger populations. However, rural areas that border more populated areas in t...