Medicoverage.com has been notified by Anthem of an upcoming Walgreens provider network status update. All current Anthem members will want to take note of this change when filling future prescriptions.
Walgreens, a pharmacy retailer, has announced its intent to exit the Express Scripts pharmacy provider network when its current contract expires on December 31, 2011.
What does this mean?
Unless an agreement is reached between Express Scripts and Walgreens, Anthem members will no longer be able to receive coverage for their prescription medications from Walgreens pharmacies, beginning January 1, 2012. This will also affect members who are using other pharmacies owned by Walgreens, most notably Duane Reade Pharmacy in the New York City metro region, Happy Harry’s Pharmacy in several northeastern states and OptionCare.
Access to other retail pharmacies within the pharmacy provider network will be available, as the Express Scripts pharmacy network contains more than 56,000 pharmacies without Walgreens. On average, there is another network pharmacy within one-half mile of a Walgreens.
Should we receive notification of a pending agreement between Walgreens and Express Scripts, we’ll post up another update.
In 2010 most health insurance companies in California ceased offering plans to individuals under 19 after last year’s federal health care guaranteed issuance law went into effect. Under the law, insurance companies were forced to accept anyone younger than 19, regardless of their health history. The insurance companies response was to stop selling any plans to individuals under 19 rather than comply with the law. This created negative feedback the White House and other patient rights groups, who accused the health insurance companies of caring more about profits than the 80,000 under 19 children with no health coverage.
The insurance companies argued that the law unfairly punished them. They claimed there would be adverse selection as parents would only enroll their kids in a health plan after they got sick and costing the companies millions. Parents with healthy kids would not pay into the health insurance system in advance because they knew they could join later at any time.
To address this Health Insurance issue, the State of California has done two things:
1) Told insurance companies that if they don’t offer under 19 insurance they cannot sell any individual health insurance in the state for 5 years. Many claim this punishment would teach companies to not over look our students and children.
2) Created an enrollment period from Jan 1. to March 1 (or in the month after their children’s birthdays) where parents can sign up their kids on child-only policy and they will be approved regardless of health condition. If under 19 individuals sign up during this time the most they would be charged would be 2x the best rate. Those signing up outside the enrollment period could be charged a much higher rate.
In response to these new state insurance law, many companies the companies — including Aetna Inc., Anthem Blue Cross, Cigna Corp., Health Net Inc. and UnitedHealth Group Inc. — resumed sales of child-only.
“The law is only effective if parents take advantage of it — the time is now,” said Assemblyman Mike Feuer. The trick is to educate parents that they need to sign up their kids before March 1 or during the month of their birthday to take advantage of the new law.
Anthem Blue Cross of California announced today that it has received the go-ahead from the California Department of Insurance to begin selling 11 plans that are now compliant with the Patient Protection and Affordable Care Act (PPACA) mandated benefits.
They are accepting paper applications now and expect online applications to being in one week. All of the new plans will continue to have an initial 12-month rate guarantee.
Anthem said that they are “continuing to work with the California Department of Insurance in order to have the remainder of our PPACA compliant plans completely reviewed and ready for the Individual market as soon as possible.”
Still pending final approval are:
* SmartSense Plus
* ClearProtection Plus
* CoreGuard Plus
* Lumenos Plus
We will update this insurance blog when new plans become available.
Today Anthem announced that they have sent out 800,000 letters to its members alerting them to this new rate adjustment. We, Medicoverage.com, are supposed to receive a list of our members affected by this new rate increase in early september. We will email all our members with an update of what increase (if any) they can expect to see.
If you have an Anthem Blue Cross plan in California and are subject to the October Rate action (or you don’t know but want to find out) please call us and we can review your plan and suggest alternatives. You can reach Medicoverage here to speak to a licensed health agent.
Anthem Blue Cross announced today that it has begun the process to remove lifetime maximum payouts to its health insurance plans. The recent health care reform legislation states that insurance plans can no longer have lifetime and annual dollar limits on “essential health benefits” as soon as September 23, 2010.
Since the U.S. Department of Health and Human Services (HHS) has yet to clarify its definition of “essential health benefits,” Anthem Blue Cross has come up with the following list of the services they believe will be affected:
Alcoholism-related services
Ambulance services
Asthma education
Bariatric surgery
Chiropractic manipulation and osteopathic manipulation services
Diabetic supplies
Diagnostic services
Durable medical equipment
Enteral formula and food products
Hearing aids
Home health care
Hospice
Infusion therapy
Kidney disease treatment
Mental health/substance abuse
Ostomy supplies
Outpatient occupational therapy
Outpatient physical therapy
Outpatient speech therapy
Pharmacy
Physician office visit (diagnostic services)
Preventive services
Prosthetic devices/limbs
Skilled nursing services
Prosthetic devices/limbs
Skilled nursing services
Transplant services
Treatment of temporomandibular joint disorder (TMJD or TMJ)
Anthem states that the listed services still may be subject to copays and other cost shares and will be phased in over time. Annual dollar limits of at least $750,000 will be allowed for plan years from September 23, 2010, to September 23, 2011. Annual dollar limits of at least $1.25 million will be allowed for plan years from September 23, 2011, to September 23, 2012.Annual dollar limits of at least $2 million will be allowed for plan years from September 23, 2012, to January 1, 2014. After January 2014 there will be no lifetime limits and annual dollar limits.
Anthem Blue Cross of California announced today that they have resubmitted new rate requests with the California Department of Insurance and Department of Managed Health Care. According to the company the average increase is 14% and, if approved, would be effective on September 1, 2010. The rate action is expected to affect 602,500 Anthem Blue Cross members.
The move comes after a very publicized withdrawal of a previous rate hike after a review from a state appointed independent auditor.
“We realize we made mistakes in our prior rate filing,” said Anthem in a memo to its agents. ” To avoid future mistakes, we’ve updated processes, such as including an external third party review and a rigorous internal peer review process by actuaries who are independent of the Individual business.” The company claims that the new rate increase comply with the Medical Loss Ratio (MLR) standard of the new health care reform law.
Will Anthem Profit from Proposed Hikes
A followup memo also stated that Anthem would not make any profit from these rate hikes: “With these filings we expect to continue to lose money on the Individual business in California again throughout 2010. Current estimates indicate that we can expect to lose more than $100 million in the California Individual market in 2010.”
California state requires that insurers notify members of rate adjustments at least 30 days prior to implementing any
change so members should get an official notification in Aug. As soon as Medicoverage knows the exact amount of individuals rate action or any other affordable family insurance options, we will send them on to our members. Just to clarify, rates for Anthem California members will stay the same until further notice.
Anthem Blue Cross health insurance company recently contracted with the Los Angeles based behavioral health provider, College Health IPA (CHIPA). The company will offer professional behavioral health services for Anthem Blue Cross members. While currently being piloted in the greater Los Angeles area, the company hopes to expand statewide to the entire CHIPA network of 300 plus behavioral health practitioners.
According to Anthem “This agreement is representative of the work we are doing towards payment restructuring programs on behalf of our customers. It also offers customers a reduction in behavioral health care costs.” How CHIPA will save money is unclear. It looks as though CHIPA utilizes its own contracted physicians to provide inpatient professional services to somehow save money.
The following is a list of Anthem Blue Cross Network Hospitals Participating in CHIPA Pilot Program. Note: not all Hospitals are participating.
Aurora Charter Oak
Aurora Vista Del Mar
BHC Alhambra
Canyon Ridge
Cedars Sinai
Chapman Medical Center
College Costa Mesa
College Hospital Cerritos
Community Medical Center , Fresno
Cornerstone of Southern CA
Del Amo Hospital
Glendale Adventist Medical Center
Good Samaritan of Bakersfield
Hemet Valley Medical Center
Henry Mayo Newhall Memorial Hospital
Hoag Memorial Hospital
Huntington Memorial Hospital
Little Company of Mary
Loma Linda
Northridge Hospital
Redlands Community Hospital
Riverside Center for Behavioral Medicine
Mission Hospital, Laguna Hills (Formerly South Coast Medical Center)
St Joseph’s Hospital of Orange County
Tarzana Treatment Center
Wellpoint CEO Angela F. Braly responded to Obama’s weekly address with a formal letter saying among other things “I was disappointed to hear you repeat false information regarding WellPoint’s coverage of breast cancer.” She also says that, “If we are going to make this law work on behalf of all Americans the attacks on the health insurance industry—an industry that provides valued coverage for more than 200 million Americans—must end.” We were able to track down the most recent one on may 8th. And we have included it below.
You will see it does mention Wellpoint / Anthem by name regarding price increases but we don’t see any reference to breast cancer recissions as featured in her letter. Here is the letter Braly sent to Obama regarding Wellpoint and Anthem health insurance. Check it out and let us know what you think:
Dear Mr. President:
I was disappointed to hear you repeat false information regarding WellPoint’s coverage of breast cancer in your weekly Presidential radio address as a demonstration of your Administration’s commitment to strong patient protection. Mr. President, I will tell you the same thing I told HHS Secretary Sebelius in a recent letter, your statement grossly misrepresents WellPoint’s efforts to help prevent, detect and treat breast cancer among our 34 million members.
To be absolutely clear: despite your claims, WellPoint does not single out women with breast cancer for rescission. Period.
The actual facts could not be clearer. In 2009, WellPoint covered the treatment of approximately 200,000 women with breast cancer at a cost of nearly $2 billion. During that same period, there were four cases nationwide where the issue of breast cancer or the possibility of breast cancer was identified in a rescission, but they were not singled out because of their breast cancer. Clearly, covering the treatment of close to 200,000 while rescinding four policies should make our intent in this regard quite clear. Our policy on rescissions has always been that it is based on fraud or misrepresentation - a policy consistent with that contained in the new legislation. In fact, we adopted the precise policy of the new legislation before any other insurer.
We should also note that we cover screening for women 40 and older, 10 years earlier than the guidelines published by your own US Preventive Services Task Force. We made this decision because we know that early detection is the key to survival, with a 5 year survival rate of nearly 100% when diagnosed at stages 0-1. This also reduces costs for the entire system by avoiding the nearly ten-fold increase in costs associated with treatment beginning after stage 3.
Mr. President, this country has a long history of coming together after tough debates. The implementation of the new health care reform law should be no different. If we are going to make this law work on behalf of all Americans the attacks on the health insurance industry—an industry that provides valued coverage for more than 200 million Americans—must end. We believe that our recent action to adopt many of the insurance reforms earlier than required by law is an indication of our willingness to work with your Administration to achieve this objective.
We agree that healthcare costs are rising at an unsustainable rate. While we continue to strive to make healthcare coverage more affordable for our members, we know that there are many causes for rising costs. Some of the most concerning cost drivers include inflation in the cost for medical services provided, increases in utilization, or the frequency with which these services are provided, and the increased cost borne by the insured population when healthy individuals choose not to carry health care coverage. These issues are of critical importance to all Americans and will require solutions that include all stakeholders in healthcare, business and government. In fact, we have repeatedly asked to meet with Secretary Sebelius, but have not yet received a response. This is simply not productive and not in the best interests of Americans.
We share your vision for a better America and look forward to working with you and your Administration.
For the second time in two months, Anthem Blue Cross of California has postponed the rate hike previously scheduled for March of 2010. Members who were originally told they would see higher prices in March will see that their premium are to remain unchanged in May 2010. There is no official word from the insurance company if or when the price will be going up again.
According to spokeswoman Kristin Binns on Friday April 23, 2010, “Members will receive adequate notification of any rate change. Until they receive information indicating otherwise, rates remain unchanged.”
Since State law requires insurers to give members at least 30 days notice before increasing premiums, Medicoverage should be able to give members fair warning of future changes.
Anthem’s Blue Cross of California announced today that it has launched a new set of health insurance plans called Premier. According to the company the offer unlimited office visits and richer benefits for preventive care and prescription drugs.
The plans which are now available for quotes now but start April 1, 2010 include the following:
$7 million lifetime payout for medical cost per member
Annual eye exams
Unlimited doctor office visits with the deductible waived
A range of preventive benefits
Generic and brand name (patented) drug coverage
You can get a quote for these plans now and we will keep you posted as we learn more about these plans.
If you currently have a policy with Anthem Blue Cross of California, you may have received a letter stating that your price will be changing as of March 1, 2010. As you may have heard in the news, this health insurance rate action will be postponed until May 1, 2010 pending further review. If you are a Medicoverage client, we have already sent you an email with an update. Please let us know if you have not received it. If you are not sure if the rate action will affect you, please contact us, as not all members with Anthem Blue Cross plans are subject to the rate action. If you are one of the individual/families who are facing the proposed monthly increase, here is what is coming next according to Anthem:
What will happen to my billing now that the insurance rate increase has been postponed by Anthem?
1) You will receive a pre-recorded message from Anthem, which provides further explanation and information detailing specifics of the March 1, 2010 Rate Action postponement and next steps.
2) A letter will go out to you that will also address how the rate increase will affect you.
3) As of March 1, 2010 your will be billed at their prior rate of premium (the same monthlyprice you were paying in January or February)
4) If you have already paid your monthly premiums at the new increased rate, you can expect a refund by the end of March.
5) Clients who pay with recurring checking or credit card deductions will be debited their previous rate for their March 1, 2010 bill.
6) Clients not on automatic-withdrawal payments will have 30 days from receipt of their new bill to pay their premium.
The steps noted above will be automatically processed and there is nothing that you will need to do right now.
What if I have already changed or canceled my Anthem Blue Cross of California coverage?
Anthem encourages you to wait until May 1, 2010 before making any plan changes. You will receive a letter which will provides you with information on what you need to do if you have already changed or canceled their health insurance coverage and would like to be reinstated to their prior coverage. You can call us for assistance if you would like to discuss your plan options or alternatives.
Anthem Blue Cross Life and Health Insurance Company of California has contacted Medicoverage to confirm that they agreed to a request by the California Department of Insurance to postpone our March 1, 2010 rates to May 1, 2010, pending an additional third-party review. The review will be conducted by Axene Health Partners, LLC, retained by the California Department of Insurance. According to Anthem, they “have already conducted an independent third-party review, we welcome the additional scrutiny by the commissioner and are confident that our rates will continue to reflect anticipated medical costs and are established consistent with actuarial principles and state law.”
In addition to the email that we sent directly to our clients, Anthem will also be contacting policy holders to inform they of the delay. They will be sending pre-recorded messages to clients beginning Tuesday, February 16th, with details about how the rate action postponement of our March 1, 2010 rates will affect them and their insurance premiums. They will also be mailing letters to members this week, with details about how the postponement of our March 1, 2010 rates will affect them.
Anthem Blue Cross of California announced today that it would postpone any health insurance plan increases until May 1, 2010. Anthem parent company Wellpoint maintained that the controversial price increases were A>?,?_"actuarially sound and in full compliance with all requirements in the law.A>?,?A_
The average health insurance premium increase according to Anthem is about 25% . The company claims that less than one fourth of members should see increases of 35% to 39%, the company said. They also pointed out that some policyholders will see their rates go down.
California State Insurance Commissioner Steve Poizner has been working with Anthem to delay the rate hike so he could have a third party review the rates and see if they are fair. “Should they find that these rate increases were unwarranted,A>?,?A_ he stated. A>?,?_"I will immediately take action to get Anthem Blue Cross to follow the law and lower their rates.”
WellPoint executive Brian Sassi, responded, “Anthem filed these rates with the appropriate regulators in November of 2009,” he said. “They are actuarially sound and in full compliance with all requirements in the law.A>?,?A_
SassiA>?,??,>s point highlights the question in our recent health insurance blog entry: Comments (0)
Just one day after we jumped on Steve Poizner for being reactionary in his handling of the Anthem rate hike, the California State Insurance Commissioner has asked Anthem to delay the proposed 3/1/2010 rate increases until 5/1/2010 to give his office time to investigate.
As of this blog posting, Anthem has yet to respond. While it is too early to know if the new rate hikes are justified or not. The new rate hike has angered many and has reinvigorated health care reform. Check out this quick sampling of sound bites:
“I can think of no better example of why we need health insurance reform,” said senator Diane Feinstein.
“They (Anthem) have clearly made themselves the poster child for why we need health insurance reform,” Assemblyman Dave Jones.
“If we don’t act, this is just a preview of coming attractions. Premiums will continue to rise for folks with insurance; millions more will lose their coverage altogether; our deficits will continue to grow larger. And we have an obligation—both parties—to tackle this issue in a serious way.” President Barack Obama
So it looks like this rate action is now a political issues. We will have to see how that affects customers who have to pay for the insurance plans. We will keep you posted.
The opinions expressed in this blog do not necessary reflect the opinions of Medicoverage Inc. Anyone is free to participate in the Health Reform debate on this site.
Today California Insurance Commissioner Steve Poizner’s office shot a press-release-type email to all licensed California health insurance agents commenting on the recent Anthem Blue Cross rate increases scheduled for 3/1/2010. He wrote:
“IA>?,??,>m alarmed by the Anthem Blue Cross health insurance rate hikes, especially in a time when the recession has forced so many people into the individual health insurance market. State law requires that insurers spend at least 70 cents of every dollar of premium on medical care. I have instructed my department to hire an outside actuary to examine their rates line by line to ensure they are complying with this state law. If we find that their rates are excessive, I will use the full power of my office to bring these rates down.”
While I commend Mr. Poizner’s commitment to keeping prices low, I need one thing clarified. Since health insurance companies have to get all rate actions reviewed by the state before they can increase rates, wasn’t he aware of these new rates before today? When was he exactly “alarmed?” Was it when he learned of the new rate or when it became a news issue? We knew about these proposed rate hikes weeks ago.
Our California Insurance Commissioner should make sure that all increases to health insurance are justified and we are anxious to learn who or what is behind the rapidly increasing rates at Anthem. I hope, however, that in the future that cost issues are his active goal, not just a reactionary response that looks good in the papers.
Now that you’re forking money over every month for your Tonik health insurance, you might as well take advantage of the services available to you. Tonik Plans are underwritten by Anthem Blue Cross of California and that’s a good thing. Blue Cross is California’s largest health insurance provider, which has bargaining power and a ton of great services. Here are some tips to get the most out of your plan:
1) Stay in the Anthem Blue Cross PPO Network.
That’s the trick to keeping your costs down. Anthem Blue Cross has a huge network of doctors and hospitals and if you use the Blue Cross Network, your cost will be way lower. So know before you go. Click here to find a Tonik doctor in your network. Search under PPO (formerly know as Prudent Buyer) Network.
It’s kind of like a mini physical. You can get a Healthy Check once a year for 25 to 75 bucks. This link will explain more and help you find healthy check centers in your area.
4) Check that Tooth.
Dental insurance comes bundled with Tonik Plans, so you might as well use it. As long as you stay in network, you’ll find that cleanings, exams and x-rays won’t cost you anything. If you need a filling, you have a $25 dental deductible then the plan pays 80% and you pay the remaining 20%. Total dental benefits paid by Anthem Blue Cross are limited to a maximum of $500 per year. Use the Anthem Blue Cross doctor finder to find a dentist in your network. Note: If you don’t get your teeth cleaned on a regular basis, you’ll soon have stank breath- so do us all a favor and make the call.
5) Pay Your Bills.
The number one reason why individuals are dropped from their plans is because they haven’t made a payment on time. Your bill is usually due on the first of the month. If you chose paper billing you will have to pre-pay for two months and there is a two dollar charge for the paper option. Want to save the earth or just having trouble remembering to get that check in the mail? Visit the Anthem CA section to access forms to fill out an automatic checking (or CC) withdrawal form. It takes 2 minutes and it can help ensure that you stay covered.
Medicoverage is an authorized independent agent. Benefits above are subject to change.
