Column 36 Network Challenges



Onward and upward we trek toward the last day of Open Enrollment, 3/31/2014! Insurers are still behind on processing and Covered CA is not particularly speedy in uploading information.  The Covered CA system was down for 5 days last week which certainly didn't help matters.

As we are enrolling more folks in the new individual plans I expect we will be facing a game of "chicken" as described in a recent article by Tracy Seipel in the San Jose Mercury News.  The article discusses the very real shortage of doctors that we see in rural northern CA and quotes Dr. Richard Thorp, a Chico/Paradise internist and  California Medical Association (CMA)  President.  The CMA represents about 40% of CA licensed physicians.  Dr. Thorpe reveals that he and his group were able to negotiate a reinstatement of their prior reimbursement rates with Blue Shield of CA.

With the bulk of the Shasta County individual and Covered CA enrollment going to Anthem Blue Cross I would encourage local physicians to concentrate on the contracts with Anthem.  We already have those insured with Anthem or Blue Shield going to Chico for urology services since there are so few contracted urologists.

I spoke to a group of Medical Office managers last week and the frustration was almost palpable.  They aren't sure of either what they are going to be paid by the carriers or even their own network status.  One woman said she had 3 patients pending surgery but they were unable to verify coverage.

One suggestion might be for patients to bring in a copy of payment verification with your ID card so they can copy it for your file.  It would at least give the provider some level of comfort that you are actually insured.  

Add to this that Covered CA has discontinued its Provider Directory "until further notice."  Peter Lee, Executive Director of Covered CA has advised that consumers can look at the insurer's website to check the list.  But remember those lists are subject to change, so you want to check with your provider as well. I believe this is what they refer to as the "vicious circle". 

It is interesting to look back at the very controversial introduction of Medicare. The measure finally passed the senate on July 9, 1965 with a 68-21 vote according to the Social Security online history Chapter 4. The nation was clearly divided and the American Medical Association bought national air time to oppose the program.  Now Medicare is the foundation of our health benefits for the aged. 

Many of my clients are quite relieved when they become age 65 and are eligible for Medicare benefits.  Even with paying the Part B & D premiums as well as a premium for a supplement, most are paying far less than they were before turning 65.  But clearly the aging of the baby boomers is already taxing this system as well. 

This a period of great tumult in the financing and delivery of health care in our country.  In the financial planning arm of our practice we encourage clients to be sure to protect themselves against catastrophic loss in many areas.  Health Care (or sickness care) is one of the biggest budget items that must be addressed. Of course this is consistent with the fact that we spend around 18% of our countries GDP (Gross Domestic Product) in this one segment of the economy. 

What will our health care delivery and financing system look like 5 years from now?  My crystal ball isn't working at the moment so I can't really tell you.  I can speculate, but that just causes people to get upset.  So for now, we simply continue to work to help our clients navigate through the sea of change.

One more Covered California reminder. If you are married and filing taxes as head of household, you are not eligible for a subsidy.