Tag Archives: California

Will California Be the First State to Offer a Public Insurance Option?

In what is a first, the California Insurance Commissioner has come out to support offering a public option for its citizens.  This is in response to several insurers pulling out of the insurance exchanges and many regions where consumers have either no choice of payer or a very limited number.

In this left-leaning state, is there enough political capital in Sacramento to make this happen?

Read more here.

CA Pushes Forward Bill to End Surprise Out of Network Balance Billing

In a previous blog post, we talked about how patients are increasingly getting billed for surprise out of network physician services even when they are receiving care in an in network facility.  In CA, the state legislature has pushed forward a bill that would make it illegal to do so.  Instead, the provider would receive either 125% of the Medicare rate or the payer’s average contracted rate for the service, whichever is higher.  The bill would also setup an independent dispute resolution process that would not include the patient if the provider does not agree w/the reimbursement.

I have some questions in my head around how this would be implemented from a payer’s perspective.  Would this only apply to professional claims where the corresponding facility bill is in network?  What would happen if the member chose to go to an out of network facility?  Would those corresponding professional visits not be covered by this?  Would claims adjudication systems need to be modified to account for this?

Aetna-Humana Merger Receives Another Blow

Could this be a sign of things to come?  The highly influential California Insurance Commissioner sent a recommendation to the Feds to block the merger between these two health insurance giants citing anti-competitive concerns.  California is, after all, the world’s third largest economy and hold’s great sway in Washington.

In a First, CA ACA Exchange Proposes to Remove Poor Performing Hospitals from Network

California is no stranger to being the first in tighter regulations across industries.  (The Clean Air Act and tighter car-emissions are immediately coming to mind).  In a first for the United States, a proposal has emerged to remove poor performing hospitals in quality indicators from the Covered California exchange policy networks.  This is not popular with either providers (no surprise there) or payers.

Read more here.