Question: When I contact a doctor to see if they take our insurance and tell them we have Blue Shield PPO, they say yes. Once I give them my subscriber number they say, “Oh, we don’t take Covered California plans.” Since my understanding is that all plans on exchange mirror those off exchange, I have asked the insurance company why certain doctors refuse. They said they can’t force doctors to take the plan. But, if the exchange plan pays exactly the same as the off exchange one, why would there be so many refusals (and trust me, there are a lot!). It has begun to feel like a plan purchased on exchange (without subsidy at this point) is like a welfare plan that no one wants to touch. Any ideas? Since we cannot switch to another plan at this point (no special circumstance) it has become quite irritating to be shoved off like we have the plague! Thanks!
Answer: Unfortunately, the joke in the health Individual & Family [IFP] insurance marketplace these days is: “Now we all (should) have insurance, but very few doctors who will take it.” [Unfortunately, with every joke there’s a bit of truth So “getting to keep your doctor,” wasn’t quite as realistic as it sounded” when our government officials mentioned this to Americans.]
The reality is many people on IFP plans have not been able to keep, or choose, the doctors they want to see. When your doctor says they take Blue Shield PPO, that means they are included in the Blue Shield PPO networks for employer-based health plans, for the most part. Given the mandated restructuring of plans by the ACA, IFP plan reimbursement rates to doctors were reduced.
Thus, for example: Covered California fosters competition between authorized carriers to yield the lowest premium rates possible in the current IFP marketplace. In order to compete, the carriers lean on their providers (doctors and hospitals) to accept ever lower reimbursement rates. Many providers refuse to participate in Covered California carrier networks resulting in “narrow networks” with fewer provider choices. Because 90% of patients are covered either by employer-based health plans or Medicare, doctors can opt of out Covered California with minimal downside to their practice. Bottom line, Employer plans currently reimburse at higher rates.
Recently, employers were asked which part of the ACA they most want to see changed. And in what’s likely to be a surprise to many, the No. 1 answer wasn’t the employer mandate.
Although 70% of the 644 employers surveyed said they’d like to see the employer mandate repealed, it still wasn’t the highest vote-getter.
What was? Repealing the excise or “Cadillac” tax. All told, 86% of employers said eliminating the tax on high-cost health plans was atop their “Wish List” of the things they’d like to see done to the ACA.
The survey was conducted by the consulting firm Mercer.
So the top five changes employers would like to see to the ACA looked like this (employers could place multiple votes):
- Eliminate the excise or “Cadillac” tax — 86%.
- Repeal the employer mandate — 70%.
- Change the definition of a full-time equivalent employee to one who works 40 hours per week — 66%.
- Repeal and replace the ACA entirely — 54%.
- Repeal the individual mandate –51%.
Just missing the top five was: Allowing the use of stand-alone HRAs to purchase individual coverage — 51% (it received fewer “strongly favor” votes than did repeal the individual mandate).
The biggest impact?
When asked about the impact of the ACA on their organizations, employers said it:
- created a significant administrative burden — 84% (with 51% saying the burden was “very significant”)
- resulted in making unwanted plan design changes to avoid the excise tax — 29%, and
- generated higher costs — 20%.
Has enrollment changed?
Employers were also asked if their health plan enrollment had changed as a result of the employer mandate, and the results closely mirror reports from the Congressional Budget Office (CBO):
- “No” — 74%
- “Yes,” an increase — 22%, and
- “Yes,” a decrease — 4%.
The CBO has reported there’s been virtually no change in the number of employees enrolling in company-sponsored health coverage as a result of the ACA.
posted from: www.HRMorning.com
Children Enrolled in Covered CA Medi-CAL Program MUST “Re-ENROLL”:
During the week of February 15, DHCS sent a notice to existing Covered California consumers who have been deemed eligible for CCHIP.
Consumers should contact CCHIP to confirm their wish to either participate in the program or to opt for a Covered California plan without premium assistance.
The non-eligible (consumers over 19 years of age) CCHIP Covered California consumers will remain enrolled in their Covered California plan with their current premium assistance amount.
For more information Children Enrolled in Covered CA Medi-CAL Program MUST “Re-ENROLL”:
OVERVIEW The Department of Health and Human Services (HHS) announced that it has launched the second phase of its HIPAA audit program, which focuses on compliance with HIPAA’s Privacy, Security and Breach Notification Rules. This second phase of the HIPAA audit program covers both covered entities and business associates. HHS’ Office for Civil Rights (OCR) […]
via HHS Launches HIPAA Audit Program — Emery Benefit Solutions