Column 41

Why not put off until tomorrow what you can do today? Apparently that is the motto of about 150.000 folks in California. Sunday-the next to last day of the 6 month open enrollment period, saw that many enrollments.  In fact, there is a report that there were 420,000 unique visitors to the site.  As expected, there was an overload to the system and there is now another extension of sorts for California.  As of this writing the extension is only on the Exchange, not off the Exchange.

The announcement from Covered CA on Monday reads as follows:

  • Consumers who were unable to create an online account or start their online application because of technical difficulties can contact a Covered California Certified Insurance Agent to explain that they attempted to get through on March 31 and experienced difficulties. Those consumers will have until 11:59 p.m. April 15 to work with the Certified Insurance Agent to complete their application and choose a plan.
  • Consumers who created an online account and completed the first page of the application by 11:59 p.m. March 31, 2014, will be able to complete their application for the open-enrollment period and must select a plan by 11:59 p.m. April 15, 2014. Those enrollees will receive coverage effective May 1, 2014.

Since most of us were feeling like accountants during a 6 month tax season this last month, it's only fitting to provide this "extension" to April 15th

There are other postponements in the wings that should make doctors and other providers happy.  The Senate has approved the 16th "patch" or temporary fix that prevents a 24% cut in physician pay for Medicare as well as postpones the implementation of the ICD-10 coding requirements.  I will write more about those in future columns.

In my practice, I often give this rather simple advice: If you are able to stay out of the emergency room and away from expensive CT and MRI machines, you may be better served with a high deductible plan.  This allows you to keep more money in your pocket rather than the insurance company's. Many people only have a few doctor visits per year and can afford to pay for those out of pocket.  If you end up with a hospitalization or surgery, it's likely you will hit the out of pocket maximum no matter which plan you choose. With most of the plans, that out of pocket maximum amount is $6350 for covered "in network" services and includes the deductible.

If you have need of more primary care, there is a new model of "direct primary care" that I find very interesting.  Prestige Primary & Urgent Care in the Sunset Shopping Center on Eureka way has a unique and cost effective way to manage this care.  For a relatively small monthly fee, members have access to unlimited primary care 7 days/week.  Dr. Jonathan Osborne is a Board Certified Family Practice Physician who heads the team at Prestige. 

They are not members of any insurance networks so all services would need to be self- billed and likely only covered under the much reduce "out of network" benefit. I was very impressed with the list of services that they cover for the fee, as well as the rate they negotiated for lab services that they must send out.  They offer a pediatric service also.

At least one opinion says that you can pays these fees from a Health Savings Account (HSA). So if you have a high deductible health plan and yet want unlimited access to primary care 7 days week, this program might work for you.

The next question is whether you can participate in this membership if you also have MediCal.  I do not have a definite answer yet.  Since our local MediCal plan is managed by Partnership Health Plan with the emphasis on managed care, I can see where this would create a conflict, even if it is not in violation of any laws.  But the reality is that the local MediCal primary care system is over-burdened. If an individual chose this option or even to simply access their urgent care clinic and pay the cash price, it might be a short term solution to the access problem.

Finally a big shout out to the Covered Shasta Stakeholders Group.  I am so grateful for the teamwork and cooperation from this group of professionals from all different segments of the community that are effected by the Affordable Care Act.  This group is formed with funding from Blue Shield of CA and I firmly believe it should be a model for all counties in the country!!

 

*Information provided in this column is "to the best of my knowledge based on press deadline. Submit your questions to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it to be answered in the paper.