BlUE SHIELD REJECTS COMMISSIONER JONES REQUEST TO DELAY RATES

Read this article - Blue Shield's behavior is unbelievable!

Blue Shield of California defies state insurance commissioner over rate hikes

The Los Angeles Times

Defying California’s new insurance commissioner, Blue Shield of California has refused to delay controversial health insurance rate hikes for 60 days that prompted an uproar among customers who are seeing successive increases over the last five months of up to 59%.

The nonprofit San Francisco-based insurer said it would submit its latest increase — effective March 1 and averaging 15% — for review by an outside expert. It pledged to issue refunds to customers if errors are found in its paperwork.

Insurance Commissioner Dave Jones immediately condemned Blue Shield’s move, saying the company acted on its own without consulting him. Jones discounted Blue Shield’s characterization of its action as “unprecedented,” noting that a new state law requires all insurance rate hikes to undergo scrutiny by outside actuaries.

Jones, however, has limited authority to stop rate increases. He can only do so in cases where an insurer spends less than 70% of premium income on healthcare expenses. (more)

This entry was posted on Saturday, January 15th, 2011 at 3:53 am and is filed under health News,insurance companies. You can follow any responses to this entry throu

"Child Only Health Insurance Policy "big disappointment in CA

After Blue Shield rate increase disaster, now the "child only health insurance policies" are another disaster for California residents.

In the last quarter of 2010 with the exception of Blue Shield no insurance carrier offered anymore child only policies for children under 19 years, due to the fact that accordingly to the healthcare reform they had to accept all children, even the unfortunate one's with severe health problems. Than the insurance commissioner threatened, if the carriers would not offer child only policies, the carriers would be banned for 5 years in the CA market.

Now most carriers have an open enrollment window for "child-only policies" for children under 19 years, which most carriers offer from January 1st to February 28th of 2011.

After investigating the individual insurance plans, I can only find PPOs plan with very high deducible Anthem, Aetna offers a $3500 deductible Plan. Blue Shield , Cigna offers a $ 5000 deductible -Healthnet and Anthem are offering also a HMO but rates are higher than any available PPO plans.

Before the Healthcare reform we were able to offer insurance PPO plan with $ 500 and $ 1000 deductible - these plans were very affordable for children. They are not existing anymore and this creates a hardship for all families in CA.

I do understand the insurance carrier having to protect themselves from the financial loss of huge claims for children with health problems, but it is not fair that all CA children cannot find suitable policies.

I will not offer a child policy with a deductible of $ 3500 or $ 5000, it is to easy for children to get sick and have to go to the emergency. Just to open the door of an emergency room cost $ 500, Parents should not take this risk!

Please offer more insurance plans for children under the age of 19 years.

The CA State should support the insurance companies with the unhealthy children in CA, and not just demand that the insurance companies carry the burden of the unhealthy children.

Our children are our future and we must make sure that they are protected!

Last year we could offer plans of

BLUE SHIELD RATE INCREASE DELAYED BY INSURANCE COMMISSIONER JONES

CA insurance commissioner Jones is requesting Blue Shield to hold off on rate increase for the planned increases of January and March increases.

Please read this article, which has been published by the insurance commissioner Jones. http://www.insurance.ca.gov/0400-news/0100-press-releases/2011/release002-11.cfm

I hope this will happen as some of my client have increase of 59 % for the Vital Shield plans.

When the old insurance commissioner Poizner had put Anthem on hold Blue Shield was one of the only carrier to be able to offer individual insurance policies last quarter of 2011,

With almost no competition insight Blue Shield must have had a record breaking quarter!

So please help your policyholders and stop this rate increases!

What is Medical Loss Ratio, and how does it hurt your agent in 2011.

The "Medical Loss Ratio" is the amount that an insurance company pays for claims divided by the premiums that people paid for insurance . A claim is a bill for medical items or services. For example, if an insurance company pays an average of 80 cents in claims for every dollar it collects in premiums, then its medical loss ratio is .80.

"Administrative Cost" is the flip side of the medical loss ratio. Administrative cost is the difference between what an insurance company collects in premiums and what it pays for claims. Administrative cost pays for claims processing, underwriting, marketing, utilization review, building up reserves, general management, and profit. Administrative cost is often shown as a percentage of the premium and ranges from 5% to 50% or more. For example, if an insurance company pays 20 cents for administrative cost for every dollar it collects in premiums, then its administrative cost is 20%.

A low administrative cost generally means that an insurance company is efficient. Consumers get more dollars of covered services for the premiums they pay. However, there is a bigger picture. A better measure of efficiency is how much health insurance contributes to people's health for the premiums they pay. This is not always the same as the most dollars of services paid per premium dollar. Some administrative costs can help you to get more for your money. For example, some administrative costs are used to help an insurance company negotiate lower prices for services or to develop programs to improve your health. Company "A" that pays $100 per x-ray may have lower administrative costs than company "B" that pays $60 per x-ray, but company "B" may provide more health for your premium dollar.

The Health Care Reform dictates that in 2011 the Medical Claim Loss Ratio in the individual market can not be higher than 0.80 and for large groups 0.85. As a result insurance companies have reduced the agent commission in half for the the individual market starting in 2011. This means we have to work twice as hard to earn the same amount of money.

This is a hardship for any agency and will cause us to reduce staff and not to hire employees. We will be able to survive but will reduce any expenditure we can avoid.

I wonder if we would tell any public employee, we are cutting your salary in half, what would happen. Although we agent are associated with NAHU, we were not able to help ourselves as we are to small a number to play any role.

It is a pity because we are the liaison to the consumer, who needs us more than ever to find an affordable health insurance coverage.

Health Insurance Affordability - What effect will the Gender Neutral rating have in California

Gender used to be a factor in determining accurate pricing in the California individual health insurance market.

Starting January 2011 accordingly to AB119 the gender rating will be eliminated for any health plan contract, and there are only gender neutral rates offered.

On maternity plans, which are very rare to find in the CA individual insurance market, there will be most likely a significant increase for male and a possible decrease for female insurance holders.

Furthermore in January all carriers have to offer individual insurance plans, which are in compliance to the health care reform. Advantages such as preventive care at no cost, no annual dollar limits for orthotics and medical equipment, will also come along with premium increases.

The only carrier who have approved rates for January is Blue Shield and Cigna.

Carriers such as Anthem Blue Cross, Healthnet, Kaiser Permanente are still not approved by the insurance commissioner.

So keep posted and visit my website and I will inform you about the newest updates in the health insurance industry

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.