Archive for the ‘California’ Category

Robert A. Berenson, Paul B. Ginsburg and Nicole Kemper3

Faced with declining payment rates, California providers have implemented various strategies that have strengthened their leverage in negotiating prices with private health plans. When negotiating together, hospitals and physicians enhance their already significant bargaining clout. California’s experience is a cautionary tale for national health reform: It suggests that proposals to promote integrated care through models such as accountable care organizations (ACOs) could lead to higher rates for private payers. Because antitrust policy has proved ineffective in curbing most provider strategies that capitalize on providers’ market power to win higher payments, policy makers need to consider approaches including price caps and all-payer rate setting.

Prosecutors are seeking documents from Anthem, Aetna, Cigna, Blue Shield, Kaiser, Health Net and PacifiCare in a probe of whether they raised rates illegally and denied payment of legitimate claims.

February 25, 2010|By Duke Helfand and Marc Lifsher

Reporting from Sacramento and Los Angeles — The California state attorney general’s office said Thursday that it had subpoenaed financial records of California’s seven largest health insurance companies as part of an investigation into whether they illegally raised customer premiums and denied payment of legitimate claims. Read more

California. The state senate has approved the creation of a government-run health care system for the state, ignoring a veto threat from Gov. Arnold Schwarzenegger. The plan would cost an anticipated $200 billion per year. Also, the California Department of Managed Health Care has released rules that limit HMO wait times. The rules require that patients be treated by HMO primary care doctors within ten business days of requesting an appointment and by specialists within 15 days. In addition, patients seeking urgent care that does not require prior authorization must be seen within 48 hours. California is the first state to set time standards for HMOs, which serve approximately 21 million state residents. For more information, visit http://www.healthhelp.ca.gov/.

Victoria Colliver, Chronicle Staff Writer

California could be disproportionately hit by a proposed annual tax in the national health overhaul legislation that critics say penalizes restrictive managed-care policies, which are far more popular in the Golden State than in the rest of the country.

An arcane provision in the Senate health bill calls for paying for expanded health benefits in part by taxing health insurers, like Kaiser Permanente, which covers about 6.6 million Californians, while exempting plans offered by large employers who pay their employees’ claims. Read more

Thank you to Attorney Gary Wickert of Matthiesen, Wickert, Lehrer, S.C. for bringing this case to our attention in his latest newsletter. Read more

by Amanda Bronstad of The National Law Journal, www.law.com

An association representing the restaurant industry has filed a petition for writ of certiorari before the U.S. Supreme Court to overturn a ruling by the U.S. Court of Appeals for the 9th Circuit upholding a law requiring employers in San Francisco to provide health insurance to their employees. Read more

Forty-seven states ban in-network providers from billing insured patients more than their required copayment or deductible and federal law prohibits providers from billing Medicare beneficiaries for unpaid balances. Some states also ban additional charges for insured patients who seek care from out-of-network providers and emergency departments. While national statistics on the practice are unavailable, economists and patient advocates estimate that consumers pay at least $1 billion annually for medical bills that they are not legally responsible to pay. Read more

In a decision that could set the stage for a test of the supremacy of a longstanding federal labor law, a panel of federal judges found Tuesday that San Francisco had the right to charge employers to help pay for its universal health care plan, the first in the nation.

The ruling, by a three-judge panel of the United States Court of Appeals for the Ninth Circuit, affirms a January decision by the same panel that required all but the smallest businesses in the city to contribute to employees’ health care costs or pay a fee to help the city provide care.  San Francisco officials hailed the decision as a major victory for its plan, called Healthy San Francisco, to provide health care for some 73,000 uninsured residents. Read more

In the matter of Sgro v. Danone Waters of North America, Inc., 2008 U.S. App. LEXIS 13973 (9th Cir. Jul. 2, 2008), an employee – Mitchell Sgro – applied for benefits from his employer’s ERISA Plan.  He incurred $412.00 in copying fees, in the process of supplying documentation and medical records to his employer as part of his claim. Read more

California

The California Assembly Health Committee recently passed a series of bills that will mandate expansion of specific benefits and health services for insurers. Benefits and services include mental health coverage (AB1877), screening and diagnostic test for gynecological cancer (AB1774), HIV testing (AB1894), maternity health care (AB1962), and breast cancer screening (AB 2234).  Insurance plans opposing bills argue that e increasing costs of the proposed mandates would total an estimated $2.7 billion annually and that 85,000 Californians would lose health insurance coverage because of the consequential higher premium costs. Read more

In July of 2006 the San Francisco Health Care Security Ordinance (”the Ordinance”) allowing the city to mandate employers with more than 50 employees to pay a fee to help cover their employee health care costs was unanimously passed by the San Francisco Board of Supervisors. 

On December 26, 2007, the U.S. District Court for the Northern District of California, ruled in favor of The Golden Gate Restaurant Association’s (GGRA) application, contending that ERISA preempted the Ordinance.  Read more