Brentwood Health Insurance Agent reports about insurance fines

Calif. regulator fines insurers for underpayment

Anthem Blue Cross and Blue Shield of California each have agreed to pay $900,000 fines. United/Pacificare is being fined $800,000; HealthNet and Kaiser Foundation Health Plan are being fined $750,000 each. Cigna is being fined $450,000; and Aetna is being fined $300,000.

Accordingly to Bloomberg Reports "California's seven largest health insurers face nearly $5 million in fines for failing to pay hospitals and physicians fairly and on time, following an 18-month audit by a state regulator, an official said Monday".

Improper claim payments are burdening health providers as they struggle to stay afloat in a bad economy, California Department of Managed Health Care Director Cindy Ehnes said.

"If providers are not paid, patient care and access suffers," Ehnes said. "The insurance companies in this state must pay their fair share of their claims promptly, fairly and on time."

Audits ordered by Ehnes in 2008 found seven health plans weren't meeting a legal threshold of paying 95 percent of claims correctly. On average, plans paid about 80 percent of claims correctly, Ehnes said.

Additionally, insurers will have to pay an uncapped amount of restitution to hospitals and health providers, which is expected to cost tens of millions of dollars, Ehnes said.

The fines and corrective actions have been negotiated and agreed upon with the insurers, officials said. Insurers also face a follow-up audit.

Nicole Kasabian Evans, a spokeswoman for the California Association of Health Plans, said the lobbying group was preparing a response on behalf of insurers.

Hundreds of thousands of claims may have been affected, said Ehnes, but the state's audit relied on statistically significant samples of each insurer's claims, so an exact number is unknown.

Ehnes also criticized what she called the hollow provider dispute resolution process discovered at five of the seven plans -- all but Anthem and Blue Shield.

Providers with a claim dispute would often end up contacting the same department that had initially denied their claim, which rarely took a "real renewed interest in the claim," Ehnes said. Corrective plans are in place to prevent that in the future, she said.

Brentwood Health Insurance Agent wants to raise awareness for women to consider Long Term Care Insurance

Why is it so important to raise awareness about long-term care? Because it is an issue that touches so many aspects of our lives.

Women, especially, bear the burden of long-term care costs for three reasons: women live longer than men; they require care longer, and because women more often assume the responsibility for their family's welfare, they often become the primary caregivers for elderly family members or their partner.

Some 980,000 women over the age of 65 are currently nursing home residents compared to only 337,000 men. Nearly three-fourths (73.6%) of assisted living residents are women. Twice as many women age 65-plus are being cared for in a home setting than men (3.27 million versus 1.68 million). According to the AALTCI.

November is Long Term Care Awareness Month. The Premiums for a middle aged person are considerably lower than the one's for a 60 year and older person. Chronic diseases, such as hypertension, can make insurance more expensive.

So do not delay further, call me to learn more about long term care insurance choices.

November is Lung Cancer Awareness Month - Brentwood Health Insurance Agent alert stop smoking

Lung cancer is the leading cause of cancer deaths in both men and women. Smoking causes 80 to 90 percent of cases of lung cancer. Don’t smoke, and avoid secondhand smoke.

Each year, nearly 200,000 people in the United States are told they have lung cancer and more than 90,000 people die from this disease. Deaths from lung cancer represent about one out of every six deaths from cancer in the U.S.

Risk Factors
Research has found several causes and risk factors for lung cancer. A risk factor is anything that changes the chance of getting a disease. Lung cancer risk factors include—

• Smoking.

• Secondhand smoke from other people's cigarettes.

• Radon gas in the home.

• Things around home or work, including asbestos, ionizing radiation, and other cancer-causing substances.

• Medical exposure to radiation to the chest.

• Chronic lung disease such as emphysema or chronic bronchitis.

• Increased age.

Prevention
You can reduce your risk of developing lung cancer in several ways.
Don’t smoke. If you do smoke, quit now.
*Avoid secondhand smoke. There is no risk-free level of secondhand smoke exposure.
*Have your home tested for radon and take corrective actions if high levels are found.
* Avoid unnecessary medical tests that involve X-ray images of the chest.
*Follow health and safety guidelines in the workplace.
*CDC helps support a national network of quitlines that makes free "quit smoking" support available by telephone to smokers anywhere in the United States. The toll-free number is 1-800-QUITNOW (1-800-784-8669), or visit smokefree.gov.

Symptoms
Different people have different symptoms for lung cancer. Some people don't have any symptoms at all when first diagnosed with lung cancer. Lung cancer symptoms can be due to the direct effect of growth of cancer cells in the lung, or due to the effect of cancer cells that have spread to other parts of the body. Lung cancer symptoms due to growth of cancer cells in the lung may include—

*Shortness of breath.
*Coughing that doesn't go away.
*Wheezing.
*Coughing up blood.
*Chest pain.
*Repeated respiratory infections such as bronchitis or pneumonia.
These symptoms can happen with other illnesses, too. Talk to your doctor if you have symptoms that concern you.

Treatment
Lung cancer is treated in several ways, depending on the type of lung cancer and how far it has spread. Treatments include surgery, chemotherapy, and radiation. People with lung cancer often get more than one kind of treatment.

People with lung cancer may want to take part in a clinical trial. Clinical trials study new potential treatment options. Learn more about clinical trials at the National Cancer Institute.

Survivors
People who have been treated for lung cancer may continue to have symptoms caused by the cancer or by cancer treatments (side effects). People who want information about symptoms and side effects should talk to their doctors. Doctors can help answer questions and make a plan to control symptoms.
For more information about symptoms and side effects, visit the National Cancer Institute's Coping with Cancer.
For information about finding or providing support for people with lung cancer and their caregivers, visit CDC's Cancer Survivorship.

Santa Monica Insurance Agent hopes that Anthem learns out of their mistake in 2010

Anthem rate increase has not only hurt their reputation and made millions of clients, non-clients including the CA Insurance Commissioner very angry. Finally the rate increases have been approved for October 1st. (a 6 month delay). To be compliant to the healthcare reform Anthem decided to switch all new enrollments after 9/23/2010 to the new compliant plans. These plans have been submitted to the insurance commissioner at the End of June but only 5 out of 43 plans are approved. And most popular plans, like the Smart Sense Plan, Premier Plan, Core Guard plan are not approved. What does it mean for you the consumer.

Since 9/23/2009 Anthem can only offer 5 plans, so in reality almost no product. Anthem's new individual insurance business is since 6 weeks at a stand still.
We agent are forced to sell other carriers such as Blue Shield, Healthnet, Kaiser Permanente or Aetna.
Aetna is the only carrier who has plans which are compliant to the Health Care reform.Unfortunately most of their plans offer only high deductibles and are not feasible for many families.
Blue Shield , Healhtnet, Kaiser Permanente are currently only selling "old- grandfathered plan".
Blue Shield just announced that any individual subscriber who enrolled after October 1st has no rate guarantee, that means the consumer can experience anytime a rate increase. Is that really what we want!!
I understand that the insurance commissioner has been angry at Anthem, as we all have. But the
current situation, with so many limited product and so few carriers does really hurt at the end the consumer.
I do not understand that anyone allowed a transition time where some carrier comply to the rules of the health care reform and other carriers do not. It is confusing to the consumer.

Their are many advantages to the new plan, such as preventive care at zero cost, free choice for females to go to their in network gynecologist, and to choose an in network pediatrician.

I hope that the Insurance commissioner will release the plans, or if the submitted rates are to high, request corrections.
But to be in the California Insurance market without Anthem really does not serve the consumer and allows carriers such as Blue Shield to offer "non rate guarantees", which are unacceptable. Even Healthnet who still offers a 6 months gurantee, is saying to the consumer that due the implementation of the Health Care Reform a rate increase for January will be most likely!
These are turbulent times and we the agents and consumer need rate clarification at once.

Although Anthem did make bad decision, we need their product! The competition in the individual insurance is very little. Having the main insurance carrier not being able to offer product, does really hurt in end effect the consumer!


Soemhow he must be so upset that the Anthem's rate, w

Brentwood Agent will help you to find the right plan for your Medicare Needs

The AEP ( Annual Enrollment Period ) will start November 15th and Ends December 31st.

In this time period Seniors are able to to review and switch from their current medicare plan , into a new Medicare Advantage or Supplemental Plan, or Drug Prescription Plan.

Understanding all the choices can be very confusing. Let me guide you through the process, and show you what Medicare Supplemental Plan changes happened in 2010.