Be prepared for Covered California changes in 2017 In 2016, Covered California, California's health benefit exchange, enrolled approximately 1.4 million individuals in qualified health plans. It is critical that physician practices understand their participation status, which products are being offered and what changes to expect in 2017. Some of the most significant changes for Covered California in 2017 are: All Covered California enrollees, including those with a PPO or EPO, will be assigned to a primary care physician. The assignment will either happen by January 1, 2017, or within 60 days of the enrollee’s ... December 14, 2016 Managed Care Covered California, Affordable Care Act, Exchange Plans, Health Insurance Exchange 0 0 Comment Read More »
Have you received a request to confirm provider directory information from BetterDoctor? The California Medical Association (CMA) has received an increasing number of inquiries over the past few weeks from practices concerned about the validity of requests for information from a company called BetterDoctor. SB 137, the new provider directory accuracy law, took effect July 1. The new law requires payors to ensure that their physician directories are accurate and up-to-date. BetterDoctor is a vendor working on behalf of 10 plans on a pilot project to ensure the accuracy of their physician directories, as required under the new law. Practices are encouraged ... September 22, 2016 Managed Care Health Insurance Exchange, Provider Directories, Provider Directory Accuracy Law, Exchange Plans 0 0 Comment Read More »
Covered California announces plan offerings for 2017 Covered California, the state marketplace for health insurance under the Affordable Care Act, recently announced the qualified health plans that were approved to offer coverage in the exchange market for 2017. All of the plans that offered coverage in 2016 will continue to do so in 2017. Three of the plans will also be expanding into new regions this year. Molina is expanding its HMO coverage into Orange County (region 18) through delegated relationships with Monarch and Heritage Network ... August 8, 2016 Managed Care Affordable Care Act, Covered California, Exchange Plans, Molina, Oscar, ACA, Kaiser Permanente 0 0 Comment Read More »
Covered California announces sharp rate hike Covered California has announced an average 13.2 percent hike in insurance premiums for 2017, a sharp increase that is likely to reverberate nationwide in an election year. The California Medical Association (CMA) is concerned the premium increases may hinder the ability of some patients to obtain insurance and access necessary medical treatment. The rise in Covered California premium rates was driven largely by its two biggest insurers, which account for about half of its enrollment. Blue Shield of California said its average rate hike is 19.9 percent, the biggest statewide ... August 5, 2016 Managed Care Covered California, Exchange Plans, Health Insurance Exchange, Affordable Care Act 0 0 Comment Read More »
Ask the expert: If an exchange patient is in the 90-day grace period and fails to pay the premium, is the plan required to pay for services provided? Maybe. Under the Affordable Care Act, exchange enrollees who receive federal premium subsidies to help pay their premiums are entitled to keep their insurance for three months after they have stopped paying their premiums. Insurance ID cards for exchange enrollees do not indicate whether the enrollee is subsidized, but Covered California recently reported that 90 percent of California exchange patients are receiving subsidies, so the likelihood of encountering a patient receiving subsidies is very high. In the first month of the grace period, federal law and California regulations require ... November 10, 2015 Managed Care Grace Period, Exchange plans, Health Insurance Exchange 0 0 Comment Read More »
California has the most exchange enrollees in the U.S. California has enrolled more people through its Affordable Care Act (ACA) health insurance exchange of any state, with about 1.4 million enrollees as of June 30, according to new federal data. California surpassed Florida – with 1.3 million exchange enrollees as of the end of June – to have the highest exchange enrollment. Nationwide, 9.9 million U.S. residents signed up for the ACA. About 7.2 million consumers purchased coverage through the federal exchange and 2.7 million purchased coverage through state-based exchanges. Of those who purchased coverage in California, 9,302 people who ... September 23, 2015 Managed Care Exchange Plans, Health Insurance Exchange, Affordable Care Act, Covered California 0 0 Comment Read More »
United Healthcare automatically opts physicians into Core narrow network product United Healthcare (UHC) recently issued notifications to 19,000 practices included in its commercially contracted provider network, advising of their inclusion in the UHC Core product. The new UHC Core plan will access a significantly narrowed network and will be marketed to employer groups seeking lower premiums for their employees. Additionally, indications are that UHC will also utilize the narrowed Core network for its potential future exchange products in 2016. UHC advised the California Medical Association (CMA) that reimbursement for the Core product line will be at the commercial fee ... April 23, 2015 General, Managed Care Health Insurance Exchange, United Healthcare, Exchange Plans 0 0 Comment Read More »
Blue Shield announces changes to 2015 exchange/mirror products On October 1, 2014, Blue Shield of California notified participating physicians that it was making changes to its Individual and Family Plan (IFP) EPO and PPO products, which are its exchange/mirror products. According to Blue Shield, the changes aim to expand access for EPO enrollees and reduce confusion by simplifying its plan names. Effective January 1, 2015, Blue Shield exchange/mirror EPO patients will have access to additional providers who are located outside of their county of residence. Previously, the Blue Shield IFP EPO limited in-network services to providers within ... November 14, 2014 Managed Care Covered California, Exchange Plans, Health Insurance Exchange, Blue Shield 0 0 Comment Read More »
