Second opinon: When leaving a job, be careful about when health benefits end
If you have questions about the practices of your managed care coverage, ask the experts at the Department of Managed Health Care.
I quit my job in May. When I called my health plan in June and July, I was told I was still covered, so I filled prescriptions on June 22 and July 16. Then my ex-employer submitted a stop-coverage date retroactive to April 24, which means those medications were no longer covered.
I want the health plan to write off this bill. I will even return the unused medications, since I can’t afford to purchase them, without coverage, for as long as I need to take the medication anyway.
– Paul Newman, North Highlands
What normally happens when you stop working for a company that provides your health benefits is that you will continue to receive benefits until the last day of the month in which you separated from the company. It is common for companies to take several weeks or months to submit the paperwork to the health plan to notify it that coverage was terminated.
So if your employer promises to keep you on the plan for any time beyond the typical end-of-the-month end date, you should get that promise in writing.
An employer can retroactively terminate coverage, and there is no way for a health plan to know that this is going to happen until it receives notice. In your case, your employer took almost three months to notify the health plan that you were no longer covered.
Your health plan’s policy is to only allow an employer to set a cancellation date retroactive by 60 days, so your coverage officially ended May 31. Any benefits received after that date would not be covered by this health plan, so the plan appears to have appropriately denied coverage for prescriptions filled in June and July.
One option would have been to sign up for COBRA coverage. Because you had group coverage, your employer is required by law to send you notification of your COBRA eligibility. If you had signed up within 60 days from the date of your employer’s notice and paid the monthly premiums to cover the months since your previous coverage ended, your new COBRA health plan would have provided benefits for the prescriptions you filled.
For those who involuntarily lose their jobs or have their hours cut, there is also a 65 percent premium subsidy offered through the American Recovery and Reinvestment Act. The subsidy qualification date was recently extended to Feb. 28.
Consumers facing changes in health care coverage status are welcome to call the Help Center at the DMHC for advice on what to do next. DMHC agents can explain the COBRA process or discuss other available options. Call (888) 466-2219 or visit www.healthhelp.ca.gov for more information.
Second opinon: When leaving a job, be careful about when health benefits end
If you have questions about the practices of your managed care coverage, ask the experts at the Department of Managed Health Care.
I quit my job in May. When I called my health plan in June and July, I was told I was still covered, so I filled prescriptions on June 22 and July 16. Then my ex-employer submitted a stop-coverage date retroactive to April 24, which means those medications were no longer covered.
I want the health plan to write off this bill. I will even return the unused medications, since I can’t afford to purchase them, without coverage, for as long as I need to take the medication anyway.
– Paul Newman, North Highlands
What normally happens when you stop working for a company that provides your health benefits is that you will continue to receive benefits until the last day of the month in which you separated from the company. It is common for companies to take several weeks or months to submit the paperwork to the health plan to notify it that coverage was terminated.
So if your employer promises to keep you on the plan for any time beyond the typical end-of-the-month end date, you should get that promise in writing.
An employer can retroactively terminate coverage, and there is no way for a health plan to know that this is going to happen until it receives notice. In your case, your employer took almost three months to notify the health plan that you were no longer covered.
Your health plan’s policy is to only allow an employer to set a cancellation date retroactive by 60 days, so your coverage officially ended May 31. Any benefits received after that date would not be covered by this health plan, so the plan appears to have appropriately denied coverage for prescriptions filled in June and July.
One option would have been to sign up for COBRA coverage. Because you had group coverage, your employer is required by law to send you notification of your COBRA eligibility. If you had signed up within 60 days from the date of your employer’s notice and paid the monthly premiums to cover the months since your previous coverage ended, your new COBRA health plan would have provided benefits for the prescriptions you filled.
For those who involuntarily lose their jobs or have their hours cut, there is also a 65 percent premium subsidy offered through the American Recovery and Reinvestment Act. The subsidy qualification date was recently extended to Feb. 28.
Consumers facing changes in health care coverage status are welcome to call the Help Center at the DMHC for advice on what to do next. DMHC agents can explain the COBRA process or discuss other available options. Call (888) 466-2219 or visit www.healthhelp.ca.gov for more information.
Californian leads effort to defend abortion rights in health plan
WASHINGTON – As a school nurse long ago, California Democratic Rep. Lois Capps worked with children of the uninsured, getting eyeglasses for them with help from the local Lions Club.
She’s one of the most liberal members of the U.S. House, a longtime advocate of universal health care. She says she’s thrilled to be a member of a Congress on the verge of passing a historic overhaul of the nation’s health care system, legislation that she says was first proposed by President Teddy Roosevelt and that “means everything to me.”
In a high-stakes battle, she’s also threatening to vote against the bill because one issue is even more important to her: abortion.
Capps’ name has suddenly become synonymous with defending abortion rights on Capitol Hill. She’s engaged in one of the biggest fights of her nearly 12-year congressional career.
Capps, of Santa Barbara, is one of 40 lawmakers threatening to derail the legislation if a House-Senate conference committee does not remove language that would restrict access to abortions.
The issue is stirring up plenty of passion in Washington, much to the satisfaction of Capps, who whipped up hundreds of backers when they flooded Capitol Hill for a day of lobbying last week.
“The stakes are now really high and the advocates are going to make all of the difference in the world,” said Capps, attending a standing-room-only abortion-rights rally and standing in front of a bright orange and white sign that said “Abortion Is Health Care.” She drew loud applause when she announced: “I am one who cannot even envision voting for health care reform that takes us back on women’s rights.”
Watching Capps, 71, at the abortion-rights rally, Jingyi Zhang, 25, of San Mateo, called her “a good leader,” and said she was happy that California was playing a prominent role in trying to protect abortion rights.
“I feel like California and New York should be the leaders because they tend to be perceived as the most forward-thinking of the states,” she said.
Capps said abortion-rights backers got “a huge wake-up call” last month when the House voted to include abortion-limiting language in its health care bill by accepting an amendment offered by Michigan Democratic Rep. Bart Stupak.
Backers of abortion rights have a new mantra, “Stop Stupak,” and they much prefer the competing “Capps Amendment,” which would not add any more restrictions to abortion coverage.
Capps may not be well known nationally, but her amendment is quickly gaining fame in the nation’s abortion debate.
“She will probably be known forever as the author of the Capps Amendment,” said Cecile Richards, president of the Planned Parenthood Federation of America.
While Capps has become a darling of abortion-rights groups, anti-abortion groups are working hard against her amendment.
“Americans, women included, reject the radical feminist vision of an abortion for every home, at government expense,” said Marjorie Dannenfelser, president of the Susan B. Anthony List, which opposes abortion rights.
If the Stupak amendment is removed, she said, the vote on final passage of the health care bill will be “the most significant pro-life vote” of the year, adding: “This will be a career-affecting vote.”
At the same time, the U.S. Conference of Catholic Bishops is backing Stupak’s amendment, saying that without it millions of insurance purchasers would be forced to pay an “abortion surcharge” because they’d be forced to pay for abortion coverage.
The House Energy and Commerce Committee approved Capps’ amendment earlier this year. Under the amendment, the government could not mandate or prohibit coverage for abortion services for plans in the health insurance exchange. It would ensure that patients have access to at least one plan that covers abortion services and one that does not.
In addition, the amendment would retain and expand existing conscience protections for health care providers who refuse to provide abortions because of their personal beliefs, and it would clarify that public funding may not be used for abortion services except in cases of rape, incest and to protect the life of the woman.
Many abortion-rights backers said the committee work was intended to be a compromise between opponents and proponents of abortion rights and to ward off a divisive fight over abortion when the bill came before the full House.
“We thought that was pretty much something that had been taken care of,” said Sacramento Democratic Rep. Doris Matsui, a member of the committee.
But when the bill came to the full House, a majority voted to scrap the Capps amendment at the last minute in favor of Stupak’s plan, which opponents say would result in the biggest rollback of abortion protections in a generation.
Under Stupak’s amendment, consumers who get government subsidies to buy insurance in the exchange could not buy a plan that covers abortions, except in cases of rape, incest or to protect the life of the women.
“My goal has always been to ensure that the voices of the majority of Americans who oppose federal funding for abortion were heard in this important debate,” Stupak said.
Democratic Rep. Diana DeGette of Colorado, the co-chair of the Congressional Pro-Choice Caucus, said abortion-rights opponents are “hijacking” the health care debate and that “they took hostages and demanded a ransom.” But she said backers of abortion rights will not trade away those rights to get a health care bill passed.
“That is a devil’s bargain, and it’s a bargain that we will not make,” DeGette said.
California Democratic Sen. Barbara Boxer, part of a team of women leading the abortion fight in the Senate, said abortion-rights backers will defeat Stupak’s amendment, but she said it’s a fight that they had hoped to avoid.
“We didn’t ask for it,” she said. “We didn’t look for it. But now that we’re in it, we will win it.”
Boxer called Capps “a smart and sharp” leader and said that supporters of Stupak’s amendment are trying “to chip away and tear away” the abortion rights guaranteed by the Roe vs. Wade Supreme Court case. She noted that no other medical services are being singled out for non-coverage under the health care bill.
“They’re picking on women,” Boxer said. “And the women of America are just simply not going to stand for it.”
Second Opinion: Provider quit the plan, so coverage ended
If you have questions about the practices of your managed-care coverage, ask the experts at the state Department of Managed Health Care. I received physical therapy for two years as post-surgical treatment for a fractured ankle, and my health plan paid part of the cost. But this year, my plan stopped making payments because the individual from whom I received these services was no longer considered a “preferred provider” or a certified physical therapist. When these claims were initially denied, I was told the reason was that “services provided by naturopathic doctors are only covered by the patient’s plan when rendered as emergency services and care.” I found that interesting, given that the plan had provided partial payment for past claims from the same provider with the exact same codes for procedure and diagnosis.
Dawn Perry, Sacramento
Your complaint highlights an aspect of preferred provider organizations that is often confusing. While PPOs provide enrollees with more flexibility in choosing providers than do HMOs, enrollees need to know the terms of their benefits to avoid unexpected expenses.
The DMHC’s review showed that for the first two years, the claims were submitted to your health plan by one of your plan’s preferred physical therapist companies. Preferred providers contract directly with a health plan to provide services to members, usually at a discount. Because your provider was recognized as a preferred provider, your health plan paid the claims. However, in June 2008, the provider asked your health plan to be removed from its preferred provider list, and changed the company name to reflect that it no longer employed physical therapists.
Although you continued to receive the same treatment from the same provider, the business relationship between your provider and your health plan had been severed. According to the terms of your coverage, physical therapy is defined as treatment provided by a doctor of medicine, or under the direction of a doctor of medicine when it is provided by a registered physical therapist, certified occupational therapist or licensed doctor of podiatric medicine. Because your provider is not a registered physical therapist, he does not meet these criteria. As a result, the services you received were no longer a benefit of your health coverage, and it appears that the health plan’s denial of your claims was appropriate.
Providers should tell their patients when they are no longer preferred providers. However, to avoid problems, patients should ask their providers before services are rendered whether they remain contracted with the patients’ health plan and therefore continue to be a preferred provider. It is also a good idea to periodically check the health plan’s Web site or call member services to confirm that the services will be covered at the preferred provider rate.
If you have questions or concerns regarding your health care coverage, call the DMHC’s Help Center at (888) 466-2119, or go to www.healthhelp.ca.gov.
Asking people to pray for good health contradicts GOP values – UNM Daily Lobo
 Washington Post |
Asking people to pray for good health contradicts GOP values
UNM Daily Lobo Monday's cartoon “The GOP Health Care Plan,” illustrates an interesting contradiction of the GOP's allegedly Christian values. … Health care issues: Paying for abortionsThe Associated Press Health care debate: Insurers deserve what they getDallas Morning News Harris offers wrong fix for health systemBaltimore Sun Examiner.com -Gerson Lehrman Group -MainStreet all 1,315 news articles » |