cmonfils | January 24, 2012

In a cavernous room just east of San Francisco, an army of phone operators fields calls from their customers. A large computer screen blinks the number of people on hold: two, and the average wait time: one minute, 12 seconds. 

These phone operators working in a non-descript office park in Alameda are employed by a large health insurance plan, and they’re willing to go the extra mile for their customers. They’ll schedule a doctor to come to your home, a pharmacist to drop off a prescription, and they’ll even help you fill out an application for food stamps. 

Category: California, Health Insurance | No Comments »
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cmonfils | January 15, 2012

MyHealthGuide Source: Todd Leeuwenburgh, Editor, Employer Health Benefits, Thompson Publishing Group, 1/12/2012, www.Thompson.com

Case: Pacific Shores Hosp. v. United Behavioral Health, 2011 WL 6402435 (C.D. Calif., Dec. 19, 2011)

A benefit administrator’s adverse benefit determination was imperfect but sufficient to comply with claims procedure rules, the U.S. District Court for the Central California district concluded in the above case.  Discrepancies by reviewing physicians and adjustments made in discharge criteria were not enough to support allegations of claims-procedure violations and overturn the denial, it held. (more…)

Category: California, Claims Procedures, Plan Language | No Comments »
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cmonfils | January 12, 2012

Reporting from Sacramento— Fewer California companies offered their workers health insurance last year, and the ones that did charged employees more for their coverage.

That’s among the findings of an annual California Employer Health Benefits Survey released Wednesday by the California HealthCare Foundation, a research and grant-making nonprofit organization.

http://www.latimes.com/health/healthcare/la-fi-california-health-care-costs-20120105,0,3760812.story

Category: California, Health Insurance | No Comments »
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cmonfils | January 8, 2012

As a general rule, state insurance laws apply to employer-sponsored insured group health plans but not self-insured group health plans. The Employee Retirement Income Security Act of 1974, as amended (ERISA) generally exempts group health plans sponsored by private sector employers from state insurance laws. However, because insurers must comply with state insurance laws, a group health plan that purchases insurance to provide benefits will be indirectly subject to the state laws applicable to the insurer. Thus, if your company sponsors a group health plan that includes any kind of insurance contract or policy, you should make sure that you keep up-to-date on state law changes and their impact on your plan, and that you properly notify your participants (and, in certain cases, eligible individuals) of any changes to their plan benefits.

Category: California, Connecticut, Health Insurance, Illinois, New York, Rhode Island, Texas, Wisconsin | No Comments »
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cmonfils | January 5, 2012

CHIP –AL, AK, CA, ID, IL, OA, KS, LA, MI, NJ, NM, OH, OR, WA, WI

Dec. 28 (Bloomberg) — Twenty-three states will share $296.5 million in U.S. payments for encouraging low-income families to enroll their children in public health programs.

Bonuses announced today reward states that streamline eligibility for Medicaid, the federal-state health program for the poor, or the Children’s Health Insurance Program. The effort is aimed at children younger than 19 from households with annual incomes of as much as $45,000 for a family of four, though some states have more generous criteria.

Category: Alabama, Alaska, California, CHIP, Idaho, Illinois, Iowa, Kansas, Louisiana, Michigan, New Jersey, New Mexico, Ohio, Oregon, Washington, Wisconsin | No Comments »
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cmonfils | January 3, 2012

Employer’s Guide to Self-Insuring Health Benefits   December 2011 | Vol. 19, No.3 

The lack of cost transparency stands in the way of health cost control because it makes plan members unable to see prices before services are actually rendered, and harms their ability to budget health spending. Problems include: (1) multiple providers; (2) multiple network-provider contracts; (3) providers that often don’t know how extensive a patient’s treatment needs are until they start treatment; (4) insurers say contractual obligations with providers prohibit the sharing of negotiated rates; and (5) providers afraid of sharing negotiated rates due to their proprietary nature. Leah Binder, CEO of the Leapfrog Group, suggested that most employers can bring more efficient purchasing to their health plan in two ways: (1) change plan documents to reward members for using high-performance providers (for example, by waiving deductibles); and (2) computerize drug ordering and management systems, which would have quality as well as cost and efficiency advantages. (more…)

Category: California, CMS, Florida, Massachusetts, Medicaid, Medicare, New Hampshire, Transparency, Wisconsin | No Comments »
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cmonfils | December 29, 2011

San Francisco Mayor Edwin Lee in November signed legislation that imposes new rules on the use of health reimbursement arrangements to satisfy the city’s health care spending law. Among other things, employees will have more time to use their account balances and have a new right to tap account balances after they terminate employment, while employers have new requirements to provide to employees a summary of contributions and reimbursement amounts. The City and Country of San Francisco Labor Standards Enforcement department has published the full law, highlighting the most recent changes, as well as sample contribution and separation of employment forms. 

Category: California, Reimbursement | No Comments »
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cmonfils | December 16, 2011

San Francisco’s Health Care Security Ordinance has been amended to require more of certain employers with workers in the City and County of San Francisco.  The amendments will take effect January 1, 2012.

The Ordinance requires many employers to spend a specified minimum amount toward certain health care expenses for their employees working in the City and County of San Francisco.  (For more information on the Ordinance, see our article, San Francisco Health Care Law Survives ERISA Preemption.)

Category: California, Health Care Legislation | No Comments »
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cmonfils | December 16, 2011

from Spencer’s Benefits Reports: For the last few years, states have been leading the way toward more comprehensive health care coverage to ensure that more people have or can obtain health insurance. With the passage of federal health care reform, states will have increasing responsibilities in regard to employer-provided health insurance benefits. Spencer’s Benefits Reports continues to provide regular updates about state health care reform.

Category: California, Health Care Legislation, Indiana, Louisiana, Minnesota, New York | No Comments »
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cmonfils | December 2, 2011

Category: California, HIPAA, News | No Comments »
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cmonfils | November 20, 2011

Employer’s Guide to Self-Insuring Health Benefits

Thompson Publishing                  November 2011      Vol. 19, No. 2

The 9th U.S. Circuit Court of Appeals ordered Blue Shield of California, the plan administrator of an insured ERISA plan, to cover a residential stay for psychological treatment despite plan terms excluding residential stays of any kind. The court even found that Blue Shield gave its plan document a sound reading. California’s Mental Health Parity Act provides coverage for “medically necessary” diagnosis and treatment of “severe mental illnesses,” whether or not it involves a residential stay. The court rejected Blue Shield’s attempt to circumscribe the Parity Act to services listed in that Act and matching the Knox-Keene Act. Then the court held Blue Shield forfeited its right to argue against medical necessity in court because it had not done so in the administrative stage.  (more…)

Category: 9th, California, ERISA, Health Insurance, Mental Health Parity | No Comments »
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cmonfils | November 16, 2011

SAN FRANCISCO—San Francisco Mayor Edwin Lee and the city’s legislators are nearing an agreement on a compromise plan to impose new restrictions on health reimbursement arrangements, potentially setting the stage for a new legal battle involving the city’s controversial health care spending law.

Category: California, Reimbursement | No Comments »
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cmonfils | November 11, 2011

Last week, San Francisco’s Mayor exercised his veto power for the first time to stop legislation designed to close an alleged “loophole” in the San Francisco Health Care Security Ordinance. This week, employers wait to see whether the San Francisco Board of Supervisors will go back to the drawing board or pass competing legislation targeting the same perceived abuse. Meanwhile, the vetoed amendment is embedded in the competing legislation so that it would become law if alternate provisions are legally challenged. The vetoed and competing legislation fail to take into account federal health care and tax laws, undermining San Francisco employers’ ability to implement long-term solutions to their employees’ health needs. 

Category: California, Health Care Legislation | No Comments »
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cmonfils | October 26, 2011

from Spencer’s Benefits Reports: For the last few years, states have been leading the way toward more comprehensive health care coverage to ensure that more people have or can obtain health insurance. With the passage of federal health care reform, states will have increasing responsibilities in regard to employer-provided health insurance benefits. Spencer’s Benefits Reports continues to provide regular updates about state health care reform.

Category: Arizona, California, Health Care Legislation, Illinois, Ohio, Vermont, Washington | No Comments »
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cmonfils | October 12, 2011

www.modernhealthcare.com

By Modern Healthcare   Posted: October 3, 2011 – 12:01 am ET

Category: California, Delaware, Maryland, Medicare, New York | No Comments »
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