California Health Insurance Rate Hikes Face Regulation

In California, health insurance rate hikes are one of the hottest issues being discussed not only by consumers, but also by the California legislature. Every year, insurance companies have been increasing health insurance premiums even though they are reporting record profit levels.

Skyrocketing premiums are one of the main reasons why some people tend to neglect their health care. High premiums are forcing millions of Californians to go without health coverage. Since 1999, individual and family health rates have gone up a shocking 139 percent!

Policyholders continue to voice their complaints on unreasonable rate hikes. This is inevitable since CA health insurance companies annually report huge profits. However, this entire ruckus with rate increases is about to change. California’s Assembly took a brave step to protect Californians from unjustifiable insurance premium rate hikes.

Health Insurance For California Faces Assembly Action To Stop Egregious Premium Increases

To address premium rate hikes, California’s Assembly passed AB 52. According to Assembly member Mike Feuer, the main proponent of AB 52, the bill would require California health insurance companies to seek the state regulator’s approval before increasing co-pays, deductibles or premiums.

California has been one of the 17 states left where regulators do not have the power to block excessive premium increases on health plans. The Department of Insurance and the Department of Managed Health Care could only review rate increases. With this bill, prices on CA health plans could be regulated. It is hoped that this would make it more available and put coverage within reach for millions of Californians who are now uninsured.

As stated by Feuer, the passage of the bill into law would be the ultimate solution to protect Californians from skyrocketing rates on individual California health plans. He also added that people should not have to live in fear that one day they would be unable to afford it in CA anymore. For most people, the protection is all that stands between them and bankruptcy in the face of devastatingly high medical bills.

What Makes Premiums On Health Insurance For California Affordable?

While this bill is still being reviewed by the Senate, there are other ways to keep California health plan premiums low. One of these options comes in the form of high deductibles. As a general rule, getting a health coverage plan with a high deductible corresponds to some of the lowest premiums available. Another option is adding a supplemental accident insurance policy to cut into that deductible for any accident-related injuries. These plans come with different amounts of coverage, up to $10,000, but keep the deductible down to $100.

Another strategy to keep CA health plan premiums low is quite a guarantee. Maintain your health with the best, and yet inexpensive, foods like vegetables that have high levels of nutrients. That makes it easy to cut both out-of-pocket costs for health care and CA health plan premiums because you won’t need health care beyond preventive services.

Understanding Health Insurance

Health insurance is a necessity for everyone who wishes to maintain or improve their health. Whether you use your health insurance for regular checkups, chronic and debilitating illnesses, or unexpected emergencies, you will find that carrying an insurance policy can result in a significant cost savings for you and your family. Those who carry health insurance often have a difficult time understanding what is covered under their policy and where they can go to obtain the services that they require. Without this necessary information, it is likely that many health insurance holders do not receive the maximum benefit that their insurance provides.

We all need health insurance to receive financial assistance for the maintenance and restoration of our health but we don’t all receive all of the assistance that we are eligible to receive. Most of us are aware that our health insurance will cover at least a percentage of certain treatments such as office visits, hospital stays and surgeries and prescription drugs that fall under their list of covered drugs but many of us don’t know what is offered beyond these basic services. Not all plans cover the same treatments so the only way to fully understand what is covered in your plan is to read your policy carefully.

Some examples of inclusions that are not well known include speech classes, hearing aids, gym memberships and a variety of other features. The only way to know for sure if these items are covered is to review your policy carefully or contact your provider. You may find a variety of services or treatments that are covered under your plan that could amount to a significant financial savings.

Knowing what is covered under your health insurance plan is very important but it is equally important to understand what is not covered under your insurance plan. You should review your plan carefully to ensure that the services that you choose will be covered by your health insuranc plan. Sometimes treatments that are deemed medically necessary by your doctor will not be covered by your plan. In this case it may be necessary to bear the burden of this expense in order to maintain or restore your health. If your claim is denied because your provider does not consider the treatment necessary, then you have the right to file an appeal.

You should carefully review the provider’s policy to ensure that you fully understand the appeal process before filing your appeal. Your claim may still be denied even if you follow proper procedure but the possibility that you will lose your appeal as a result of improper filing is greatly reduced. You should review your insurance plan carefully before undergoing preventative treatment to determine whether or not the treatment will be covered. In an emergency you may not have the opportunity to review your policy before authorizing treatment but you will have the opportunity to appeal if the treatment is not covered.

Knowing which doctors you can visit can also be confusing. Some health insurance policies allow you to visit any doctor you choose while others limit you to the participating doctors in their plan. Also, whether or not you can see a specialist is often difficult to determine. Usually, the receptionist at the doctor’s office will be able to tell you whether or not they accept your health insurance policy before you schedule your appointment. You can also call your customer service representative to inquire as to whether a specific doctor will be covered.

Health insurance can literally be a life saver but understanding your policy can be a nightmare. In most cases carefully reading your policy to determine the covered treatments as well as the exclusions and limitations may help you understand your policy better. If after reading through your policy you still have general or specific questions you should contact the customer service representative for your policy. They will be able to provide you with answers that will enhance your understanding of your policy. Knowing what is covered and what is not covered are the most common misunderstandings involving health insurance.

It is also important understand your provider’s appeal process in case you ever incur claims that are denied. In all cases your health may necessitate treatment that is not covered and you will have to make the difficult decision of whether or not to authorize the treatment.

Understanding HMO, PPO and FFS Health Insurance Plans

Health insurance is offered in various forms today. Traditionally, health insurance plans were indemnity plans; the insured paid a premium, the physician provided health care services, the health insurance plan was billed, and the health insurance plan paid for covered services. As health care costs became astronomical, health insurance companies developed different plans that were aimed at providing quality health care at affordable prices. Managed health care became the buzzword for the health insurance industry, and health insurance plans became more complicated.

Health maintenance organizations, or HMOs, and preferred provider networks, or PPOs, have largely replaced the traditional indemnity health plan. HMOs and PPOs utilize strategies to contain health care costs. These health plans are similar in certain ways. Both HMO and PPO plans contract with health care providers to provide health care services at reduced rates for the health insurance plan members. Typically both plans require the the member have a primary care provider, or PCP, who serves as a “gateway” to coordinate care for the member, and all specialty services are accessed by referral from the PCP. Both HMOs and PPOs require that certain services and products, usually the more costly ones, be reviewed by the health insurance reviewers for prior approval or prior authorization before the service is rendered. The health care provider must submit justification for these services as “medically necessary”, and the reviewer determines whether the service is a covered service. The plans do make provision for emergency situations that cannot wait for prior approval/authorization, but still require an approval process.

HMOs and PPOs differ in significant ways, however. A PPO plan often covers services rendered by providers that are not in the plan network, though usually at a lower rate than given for network providers. HMOs usually offer no coverage for out-of-network health care providers.

Advantages of HMO/PPO plans typically include lower health insurance premiums than those of traditional health insurance plans. HMOs and PPOs often offer coverage for preventive and health maintenance care not covered by indemnity plans. The health plan member is usually not required to file claims for health care services; contract providers bill the health insurance plan directly.

Disadvantages of these managed health care plans include limiting coverage to providers in the health care plan. Plan members must change primary care providers if their provider is not in the health plan network. Many members do not want to change health care providers. Another disadvantage is that prior approval/authorization processes can be time-consuming and slow down the delivery of needed health care services. Specialty health care can only be accessed through referral from the PCP.

In summary, HMOs and PPOs offer lower premiums and increased coverage, but limit members to their network of providers. Indemnity plans allow the member to see the health care provider of their choice, and to access specialty care when they want, but usually pay higher premiums for health insurance coverage. Ultimately the health plan member must decide whether choice of physician and access to specialty care are worth the higher premiums. Whatever plan is chosen, it is vital for members to know their health insurance plan, including what services are covered and what providers are in network.