California Department of Insurance detectives, assisted by multiple law enforcement agencies, arrested Chris Bathum and Kirsten Wallace on multiple felony counts of grand theft, and identity theft for allegedly conspiring to defraud patients and insurers out of more than $176 million through an elaborate conspiracy. Simultaneously, search warrants were also executed at 15 locations throughout Los Angeles and Orange County.
Cigna California 2017 Individual and Family Plans
Cigna has released their 2017 health plans available in select counties of Northern and Southern California. Cigna has decided not to pay agents commissions for 2017. (Cigna Cuts All Agent’s Commissions to 0% for 2017) Consumers will have limited options for assistance with enrollment and the explanation of the health plans from Cigna in 2017. Most all Cigna plans have been converted to EPO plans. The exception is one Bronze plan that still remains a PPO product.
Anthem Blue Cross Simple Off Exchange Plan Change Forms
Anthem Blue Cross has made it easier for members with off-exchange plans to change plans without filling out a new application. Current off-exchange members who want to change from their 2016 ACA compliant Anthem plan (purchased off the exchange) to a different off-exchange plan for 2017 can use the appropriate new form instead of having to complete the full enrollment application.
Health Net 2017 Californnia Individual and Family Plans
For 2017, Health Net is offering a variety of health plans throughout California. There are EPOs, HSPs, HMOs, and PPOs plans. Some of the plans are offered through Covered California and some, like the PPO plans, are only offered off-exchange direct from Health Net.
Blue Shield’s New PCP Assignment FAQs for PPO Plans
In 2017, we will be selecting a primary care physician (PCP) for you so you can begin building a relationship with your doctor. As a PPO member, read our frequently asked questions about choosing a PCP.
Department of Insurance Receives Health Plan Compliance Grant
The Centers for Medicare and Medicaid Services at the U.S. Department of Health & Human Services announced today it awarded a $1.84 million grant to the California Department of Insurance to enhance enforcement of key market reforms under the Affordable Care Act.
Health Plan Report Cards Released for 2017 Open Enrollment
The California Office of the Patient Advocate (OPA) has released their health plan quality report cards in time for the 2017 open enrollment period. Now in its 16th year, the 2016/2017 OPA Health Care Quality Report Cards are available online at www.opa.ca.gov. This timely release of the Report Cards is critical as consumers prepare in making the important decision of choosing a new health plan for themselves and their families during 2017 open enrollment. Quality matters when consumers choose a health plan or medical group, and this free tool helps ensure they have the information they need to make an educated decision.
Health Net 2016 PPO Plans to be Discontinued
Health Net has announced that they must discontinue their 2016 PPO plans at the request of the California Department of Insurance. Health Net had originally filed for a 23% rate increase for their 2017 PPO plans. Through negotiations with the Department of Insurance, Health Net lowered the rate increase to an average 12.1%. Because of the changes to the PPO plans, Health Net will need to cancel their 2016 PPO Plans on December 31, 2016 and offer a new PPO plan design to new and existing members. On October 4, 2016, the Department of Insurance concluded that the lower rate increase was not unreasonable.
CalOptima Orange County Medi-Cal Data Breach
On or about August 17, 2016, a departing CalOptima employee downloaded data, which included protected health information, to an unencrypted USB flash drive. Shortly after, the departing employee returned the USB flash drive to CalOptima. While we are still investigating the contents of the flash drive, we do not believe the information was shared.
Specialty Drug Management Changes for Anthem Blue Cross Health Plans
Health care costs continue to rise, and specialty drugs are a big contributor. These prescription medicines are used to treat complicated and chronic conditions, such as hepatitis C, cancer and multiple sclerosis. As specialty drugs become more widely used, we’re looking for new ways to control costs while keeping members healthy. That’s why we created our Right Drug Right Channel (RDRC) program.
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