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UCLA’s Center for Health Policy Research

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How Calif. slows premium increases

Here’s a look by Governing.com into how California has been able to slow rises in health-insurance premiums better than than any other state.

Governing says:

“California’s system is unique thanks to its rigorous vetting process for insurers that want to participate in its marketplace. At the onset of the ACA, the state hired a team to look over health plan proposals from insurance companies and excluded any that it deemed uncompetitive. Unlike in any other state, every plan in California has identical benefits, so enrollees are ‘choosing a plan basically just for the network,’ said Shana Charles, faculty associate with UCLA’s Center for Health Policy Research. 

“Because the state chooses the plans, insurance companies are under pressure to offer lower rates.”

“’It’s an example of good governance,” Ms. Charles told the publication. ”Government is taking a referee role and telling these insurance companies, ‘This is the minimum standard, so show us what you’ve got.’”


Those ‘balance billing’ blues

 

This Los Angeles Times story tells how patients get very unpleasant surprises when out-of-network costs lurk in in-network hospitals.

Consider those surprise bills from physicians who don’t participate in patients’ health plans but who do practice in hospitals that do. With no contract in place to dictate how much they get paid for services, they can bill patients for charges beyond what insurance covers.

The doctors  charge for the balance of the bill not covered by insurance. It’s  called “balance billing.”

“It’s an abuse of the implicit trust that you have with your doctor and with your healthcare providers,” Gerald Kominski, director of UCLA’s Center for Health Policy Research, complained to the Los Angeles Times.

The paper noted that {f}ederal law doesn’t protect patients from these surprise bills. The Affordable Care Act requires insurers to cover out-of-network emergency services at in-network rates, but it doesn’t stop doctors from balance billing.

And figuring out which doctors participate with which health plans can be easier said than done.

 

 


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