CA Health Insurance Applications: Insurance RX
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Insurance Rx?

  A normal Application for most Carriers is about 15 pages, which consist of 20 medical History questions going back 10 years as well as all doctors, last visit and all prescription drugs. The same goes for the online application but the difference is they will not let you move on until you completed everything properly.

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Californians should not lose their health insurance because of inadvertent mistakes on complicated enrollment applications. So proposed new regulations that crack down on that abusive practice offer a necessary consumer protection. And they should be standard practice for all health insurers in the state.

The state Department of Insurance last week unveiled proposed rules governing the individual insurance market — for people who do not get health coverage through their employer. The new regulations could be in place by year’s end.

The rules create new requirements for insurers to meet before they can revoke a policyholder’s coverage. The regulations would oblige health insurers to provide easily understood application forms. And the rules would mandate that insurers thoroughly check applicants’ medical histories, including discrepancies on enrollment forms, before issuing policies.

 

Those steps seem like common sense, but are not required practice in California. State law lets insurers cancel individual policies if customers misrepresent their medical history, to prevent people from fraudulently obtaining health insurance. But insurers have interpreted the law to mean they can rescind coverage for any inconsistency or incorrect information on an application form — even if insurers only discover the inaccuracy after customers file claims. And because insurance forms are confusing, innocent mistakes are common.

But insurers need to determine whether a customer is a good risk before medical expenses start piling up. A system that lets insurance companies revoke coverage for inadvertent errors after customers file a claim subverts the whole point of insurance.

Nor is that practice a rarity. The Department of Insurance reached settlements with three insurers in 2008 and 2009 regarding nearly 4,000 people whose policies insurers had improperly revoked between 2004 and 2008. The Department of Managed Health Care, which oversees HMOs, signed insurer settlements in 2008 covering another 3,300 people who wrongly lost coverage during the same period.

The state’s fragmented regulatory structure means the new rules would only apply to insurers overseen by the Department of Insurance. The Department of Managed Health Care said last week it is not pursing similar regulations, but relying on the agreements with five large insurers. Insurers and consumers would be better off with a consistent approach for everyone.

Still, the proposed regulations properly curb abuses that put insurer profit before good-faith practices. Even a partial solution still counts as progress.

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I think its a great idea to make the Health Insurance Application easier for Applicants. When completing the forms, its very easy to miss something, forget about a medical issue from 9 years before or not have every date, doctors number and address.

Source: http://www.pe.com/localnews/opinion/editorials/stories/PE_OpEd_Opinion_S_op_06_ed_insuranceregs1.4ec0316.html

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Obama plan would provide health care for all

More articles on Obama and individual mandate for Health Insurance Coverage.

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Obama plan would provide health care for all

By ERICA WERNER – 4 days ago

 

WASHINGTON (AP) — President Barack Obama says he’s open to requiring all Americans to buy health insurance, as long as the plan provides a “hardship waiver” to exempt poor people from having to pay.

Obama opposed such an individual mandate during his campaign, but Congress increasingly is moving to embrace the idea.

In providing the first real details on how he wants to reshape the nation’s health care system, the president urged Congress on Wednesday toward a sweeping overhaul that would allow Americans to buy into a government insurance plan.

Obama outlined his goals in a letter to Sens. Edward Kennedy, D-Mass., and Max Baucus, D-Mont., chairmen of the two committees writing health care bills. It followed a meeting he held Tuesday with members of their committees, and amounted to a road map to keep Congress aligned with his goals.

“The plans you are discussing embody my core belief that Americans should have better choices for health insurance, building on the principle that if they like the coverage they have now, they can keep it, while seeing their costs lowered as our reforms take hold,” Obama wrote.

Obama has asked the House and Senate each to finish legislation by early August, so that the two chambers can combine their bills in time for him to sign a single, sweeping measure in October. In a statement Baucus welcomed the assignment.

“I will stop at nothing to deliver a health reform bill that works for families and businesses to the president this year,” Baucus said.

Covering 50 million uninsured Americans could cost as much as $1.5 trillion over a decade, and cost is emerging as a major sticking point. Obama didn’t offer new solutions to that problem in his letter Wednesday but did say he’d like to squeeze an additional $200 billion to $300 billion over 10 years from the Medicare and Medicaid government insurance programs for the elderly, disabled and poor.

He said he’d do it through such measures as better managing chronic diseases and avoiding unnecessary tests and hospital readmissions. Savings from such measures are uncertain.

Medicare benefits cost the federal government about $450 billion a year and Medicaid about $200 billion. Obama already has targeted the programs for some $300 billion in cuts over 10 years in the 2010 budget he released in February.

He also said he’s open to congressional proposals to let an independent commission identify cuts to Medicare which would take effect unless Congress rejected them all at once, similar to how military base closures are handled.

The president said he supports a new health insurance exchange that Congress is crafting, a sort of marketplace that would allow Americans to shop for different plans and compare prices.

All of the plans should offer a basic affordable package, and none should be allowed to deny coverage to people with pre-existing conditions, Obama said — big changes from how private insurance companies operate today.

“I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans,” Obama wrote, weighing in firmly on one of the most controversial issues in the debate. “This will give them a better range of choices, make the health care market more competitive and keep insurance companies honest.”

Republicans strongly oppose a public plan, as do private insurers, who contend it would drive them out of business.

“A government-run plan would set artificially low prices that private insurers would have no way of competing with,” Senate Minority Leader Mitch McConnell said Wednesday on the Senate floor.

The idea of what Obama called a “hardship waiver” for individual Americans too poor to buy care splits the difference between where he was during the presidential campaign and where Congress appears to be heading.

In the campaign, Obama did not support requiring everyone to buy insurance, putting him at odds with then Democratic rival Hillary Rodham Clinton. Congress is looking at doing so. The hardship waiver idea is under consideration by the Senate Finance Committee, which also is considering giving tax credits to certain individuals so they can afford health care. Kennedy and House Democrats are looking at giving subsidies to the poor to help them buy coverage.

The letter didn’t address the issue of taxing health care benefits. Obama opposed that during his campaign but Congress is now considering it, and Obama hasn’t shut the door on it.

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As the Health Reform continues, I think Obama is realizing there are not many options to get the country Health Care. By setting up a MediCare like system looks like the only way to provide for all.

Source: http://www.google.com/hostednews/ap/article/ALeqM5gap9wCaolRYguYQesA2i2Yr98yLgD98JPEQG1

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Private insurance companies push for ‘individual mandate’

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‘individual mandate’ would only benefit everyone. The Health Insurance Carriers will be forced to make getting a plan obtain coverage.

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Some may find it hard to believe that the U.S. health insurance industry supports making major changes to the nation’s healthcare system.

The industry, after all, scuttled President Clinton’s healthcare overhaul bid with ads featuring “Harry and Louise” fretting about change.

But this time, it turns out, the health insurance industry has good reason to support at least some change: It needs it.

Private health insurance faces a bleak future if the proposal they champion most vigorously — a requirement that everyone buy medical coverage — is not adopted.

The customer base for private insurance has slipped since 2000, when soaring premiums began driving people out. The recession has accelerated the problem. But even after the economy recovers, the downward spiral is expected to continue for years as baby boomers become eligible for Medicare — and stop buying private insurance.

Insurers do not embrace all of the healthcare restructuring proposals. But they are fighting hard for a purchase requirement, sweetened with taxpayer-funded subsidies for customers who can’t afford it, and enforced with fines.

Such a so-called individual mandate amounts to a huge booster shot for health insurers, which would serve up millions of new customers almost overnight.

“I think that’s why we’ve seen the industry basically trying to play the administration’s game,” said Jane DuBose, an analyst with industry tracking firm HealthLeaders-InterStudy. “They really could be licking their chops over the potential here.”

The industry says its interest in change flows not from narrow self-interest but from broader concerns.

“What’s driving this is we have 47 million people who don’t have access to the system, who get help through emergency rooms, and that results in higher costs and inefficient care,” said Robert Zirkelbach, a spokesman for industry trade group America’s Health Insurance Plans. “There’s both a social and economic reason to get everybody in the healthcare system.”

Jay Gellert, chief executive of Woodland Hills-based Health Net, said industry support for certain changes is driven by “a recognition that public frustration with many of the problems in the system [is] increasing pretty significantly. So I think there’s as much of a commitment to this because we’ve seen other industries where they haven’t dealt with issues early enough, like financial services and auto, and that’s not a happy place.”

Still, industry observers say, private insurers need the government’s help to transform some of the nation’s 45 million uninsured residents into paying customers.

Private insurers lost an estimated 9 million customers between 2000 and 2007. In many cases, people lost coverage because they or their employers could no longer afford it as premium increases outpaced wage growth and inflation.

Recession job losses are adding to the toll. Some economists estimate that every percentage-point increase in the jobless rate adds 1 million people to the ranks of the uninsured.

The industry’s real trouble begins in 2011, when 79 million baby boomers begin turning 65. Health insurers stand to lose a huge slice of their commercially insured enrollment (estimated at 162 million to 172 million people) over the next two decades to Medicare, the government-funded health insurance program for seniors.

“The rate of aging far and away exceeds the birth rate,” said Sheryl Skolnick, a CRT Capital Group healthcare investment analyst. “That’s got to be very scary. . . . This is the biggest fight for survival managed care has ever faced, at least since they went bankrupt in the late ’80s.”

With Democrats in power and public sentiment in favor of change, the industry can’t afford to flatly oppose it, said Julius Hobson, a Washington lobbyist for hospitals and insurers with the law firm Bryan Cave.

“This time, you get the sense something is going to happen,” he said. “So to stand up and just say no is probably not wise, because politically you could get run over.”

For insurers, getting “run over” would be the adoption of a so-called single-payer plan, in which the government pays all medical bills. Such a plan, though widely viewed as politically unfeasible this year, would wreak havoc on the private insurance market.

The best way for the industry to preserve the private insurance market — and derail the campaign for a single-payer system — may be to go along with more palatable proposals on the table now, said Jeffrey Miles, a healthcare analyst and president of the Miles Organization, a Los Angeles insurance brokerage firm.

“If healthcare goes down this year, you are going to end up with single-payer care much sooner than anyone expected,” he said.

But there is a limit to how much change the industry will abide. It draws the line at proposals, supported by President Obama and others, to offer consumers a public insurance alternative to private coverage.

The idea is that consumers could buy into a government-run health plan, such as or similar to Medicare or the federal employees insurance program

Proponents say that if consumers are required to buy coverage, it is only fair to give them a public option.

In a recent letter to Senate Finance Committee Chairman Max Baucus (D-Mont.), for example, Jerry Flanagan of the Santa Monica-based advocacy group Consumer Watchdog wrote that adopting an individual mandate without a public alternative would amount to “a bailout for HMOs — whose greed, waste and indifference to our health have created the current mess.”

The industry fears that the government would force lower fees on hospitals and physicians, enabling a public health insurance plan to offer consumers a better bargain.

That, they say, would make it hard for private companies to compete for customers. Insurers also fear that a public option could easily be converted later into a single-payer healthcare system.

Health insurers don’t see a public plan “as the nose of the camel under the tent; they see it as the front half of the camel under the tent,” said Robert Laszewski, a former insurance company executive and industry consultant.

“They are interested in 45 million new customers,” he said, “but the first thing

in everybody’s mind is preserving their right to do business in a way that can be profitable and meet shareholder needs.”

lisa.girion@latimes.com

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the Health Insurance Industry needs a lot help. The rates are outrageous and only growing, underwriting is imposable and the ever growing premiums are forcing people to go without. If anything that the health care reform will do is bring change for all.

Source: www.latimes.com

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County will consider five health insurance plan bids:
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California climbed to #24 – up one spot from its 2007 ranking as the 25th healthiest state to live in – according to a 2008 study by the United Health Foundation.

Health Net will pay $1.95 million in recession suit

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Class action suit regarding Health Net policies that were canceled after 926 people were ill.

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By anne

Created May 27 2009 – 1:20pm

Marking another landmark in a titanic struggle between health plans, providers and consumers over the right to cancel policies, Health Net has agreed to pay $1.95 million to California hospitals to settle claims over rescission of individual policies.

The California Hospital Association had launched a class-action suit against Health Net bringing 200 hospitals together. It arose from Health Net’s decision to revoke individual policies during the period between February 2004 and October 2007.

The health plan had previously settled with the California Department of Insurance for $3.6 million in penalties, plus up to $14 million in reimbursements for medical charges, in regards to 926 people whose policies it canceled retroactively [1] after they became sick.

Under the terms of the settlement, Health Net has agreed to set up a fund to reimburse hospitals for services they provided to rescinded members. Health Net has also agreed to give hospitals a list of rescinded patients, so patients will be free from actions by creditors over unpaid bills.

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Good to see that Health Net did not get away with unpaid bills and breaking the law. Hopefully, this will not happen again.

Source: www.health-insurancecalifornia.com

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Governor Puts Welfare And Kids Health Insurance On Chopping Block

Healthy Family Requirements:

• Be age 18 or younger.
• Not be eligible for no-cost Medi-Cal.
• Children in families with incomes within the Healthy Families Guidelines.
• Live in families without health insurance from an employer for the past three months.
• Meet citizenship or immigration requirements.

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Deep cuts to health and human services are being proposed for California, with more to come on Friday. Faced with a $24 billion deficit, Gov. Arnold Schwarzenegger’s latest request would eliminate the state’s main welfare program, CalWORKs, which provides grants to low-income parents. The governor also proposes ending the Healthy Families program, which provides health insurance for one million low-income children.

In all, it’s an additional $3 billion in budget cuts. Anthony Wright, executive director of Health Access California, says it will prompt the most profound rollback of health coverage in the state’s history.

“California would be the only state in the nation that doesn’t cover the low-income children eligible for Healthy Families. It would have ripple effects throughout our healthcare system and our economy.”

Wright points out that eliminating the programs means the state will lose millions of dollars in federal funds, as well.

“That’s why some of these cuts really are irrational and reckless – and other alternatives, including revenues, need to be considered.”

The cuts could be avoided, Wright insists, if the governor would take a more balanced approach that includes raising money – but Schwarzenegger has said tax increases are off the table. The governor also says he realizes the cuts will hurt families, but claims he has no choice.

Lori Abbott, Public News Service – CA

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Ending such programs will only hurt the state. Healthy Families is low cost insurance for children and teens.It provides health, dental and vision coverage to children who do not have insurance and do not qualify for free Medi-Cal.

Source: www.publicnewsservice.org

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Medical bills underlie 60 percent of U.S. bankrupts:

http://ping.fm/d59Fv

Setting up Ping.fm going to save me so much time, phew.