2.  Guard your insurance information: An insurance card should be treated like a credit card; if lost or stolen, report it, if someone calls asking for your medical number, do not provide it, regardless of who they say they are.

3.  Don’t fall for illegitimate offers:  For example – A common (and illegal) tactic health care thieves attempt is offering cash or other rewards to switch to another plan. The thief will request your medical number to complete the transaction.

4.  Make sure you get all your medication: If your doctor prescribed 40 pills, make sure you received 40 pills. Also confirm you received the correct drug, and only the generic version if your doctor allowed the substitution.

5.  Check your receipt:  Medicare members get a receipt called an Explanation of Benefits   (EOB).  Make sure you haven’t been billed for services you did not receive, were charged by a provider you did not see, or were charged for dates you were not there.

Report suspect charges immediately:  to report Medicare fraud, immediately contact 1-800-633-4227 (1-800-MEDICARE), visit Medicare’s website at www.medicare.gov, or contact your health provider at the number on your ID card.

Read the complete article: Anthem Blue Cross Enlists Members’ Help in Catching Medicare Fraud.

Most Urgent Care Centers offer both basic laboratory work as well as x-ray services. The cost of a visit may be up to half the cost of a visit to an emergency room. According to Anthem Blue Cross, “policyholders face average emergency room co-pays of $150, but only $10 to $40 in the other settings” (LA Times).  Furthermore, while the average wait time in an emergency room varies according to the number of critical patients, a person with a non-life threatening injury or illness may wait over two hours to be seen.

In an Urgent Care facility, 57% of patients wait 15 minutes or less, and 80% wait less than 60 minutes (UCAOA). Urgent care centers have extended evening hours as well as weekend services.  They can also be an alternative to a visit to your primary care physician for the services listed below.

Urgent Care Centers are best for the following:

• Cuts
• Sprains
• Earache
• Sore Throat
• Eye Injuries
• Flu
• Fever
• Diagnostic tests (i.e. strep throat)

According to the American College of Emergency Physicians a visit to the Emergency Room is appropriate for:

• Chest pain
• Uncontrolled bleeding
• Sudden or Severe pain
• Coughing or vomiting blood
• Difficulty breathing
• Shortness of breath
• Sudden dizziness/weakness/vision changes
• Severe or persistent vomiting or diarrhea
• Changes in mental status

All centers accept insurance plan co-pays.  Checking your insurance plan for urgent care coverage could save you both time and money.

Day 1 – Court Will Hear Arguments Around the Anti Injunction Act (AIA)

• AIA is a federal law that states Courts cannot consider challenges to a tax until the tax is assessed.
  • The Court hired an attorney to argue this as both sides currently agree the act does not apply.
  • One of the questions the Court must consider is whether the penalties imposed by the health care law are taxes.
  • If the Court rules that the AIA does apply to the health care law, the challenge could not be heard until after implementation (2014).  (NY Times)

Day 2 – The Crux of the Case: The Individual Mandate – is it Constitutional?

• The government considers the mandate constitutional; and argues that Congress has the power to regulate commerce and the power to tax as stated in the Commerce Clause (Article 1, Section 8) of the Constitution.
• The opponents argue that this would regulate inactivity, versus activity, and questions the requirement to purchase a product or service; and consider this an intrusion on individual freedom.  (USA Today)

Day 3 - The Court Considers, if the Individual Mandate is Unconstitutional, What Happens to the Rest of the Law?

• Three arguments will be heard:
  •  The opponents argue that if the law is considered unconstitutional, the entire law is void.
  • The government will argue that the majority of the law will stand, and only that pertaining to requiring insurance companies to accept all applicants including those with pre-existing conditions would be void.
  • The Court hired a third attorney to present a different perspective – that only the Individual Mandate would be voided and all other aspects of the law will remain intact. (NY Times)

• In the afternoon the Court is hearing arguments regarding the additional conditions of expanding the Medicaid Program to the States.
  • The States argue the expansion of the program and how it is tied to the Federal partnership for Medicaid.
  • The Government argues that changing conditions are normal in all Federal Programs. (NY Times)

The final ruling is expected in late June.

With the passage of SB 299, there are significant changes to California’s Pregnancy Disability Leave for small businesses with five or more employees.  If the employer offers group health insurance and the employee has opted for coverage, the employer is now required to maintain the group plan coverage (up to four months) for employees on a PDL, and the cost to the employee is not to exceed the normal employee contribution (if there is one).  This is a significant change to current law, which does not require the continued insurance coverage during a PDL.

View the complete SB 299 Bill.

View the Pregnancy Disability Leave summary and the full overview of the new 2012 Laws.

At the start of a new year, many of us reflect on actions we can take to improve our lives, resulting in the leading resolution of better health. One possible step to take toward a healthier lifestyle involves taking advantage of your health plans 100% coverage of preventive care services. The majority of employer sponsored health plans include this benefit due to the passing of Health Care Reform in 2010.  Individual plans may also include this benefit, with the exception of “grandfathered” plans.

An annual preventive care physical exam could help stay on the path to good health, detect problems early, and in some cases, save lives. Depending on age, there are lists of screenings, tests, and vaccines that are covered, in addition to a yearly annual exam.  Always consult with your physician to help determine which tests are most appropriate.   The exam, and additional preventive care tests are covered at a 100% rate, as long as you are using an in-network provider.  For a list of covered screenings and immunizations, please refer to the links below.  For specific questions related to your plan, please contact Gray & Troy Insurance (805)540-7010.

Anthem Blue Cross Preventive Care Benefits

Blue Shield Preventive Care Benefits

According to Lloyd H. Dean, president and CEO of CHW, “Changing our name to Dignity Health reflects our commitment to excellent care for all in need and to being a national leader in quality care.  The new structure supports our long term plan to grow and coordinate care, while reinforcing our mission of service to the communities we are so privileged to serve” (CHW News Release).

Currently CHW is the fifth largest health care organization with 40 hospitals in its system located in California, Arizona and Nevada.  One of the goals of the change will be to triple in size with mergers and affiliations, growing nationally while maintaining the outstanding medical care it has provided to its patients (USA Today).

According to Sister Judy Carle, (who will remain a member of the board of directors), “Our mission, our vision, our values are not changing nor will they change.  This particular restructuring can carry on that mission” (Kaiser Health News).

This change will have no effect on patients or medical care provided at the 40 hospitals in the system.

View the IRS document for more information about the 2012 contribution limits.

Tenet facilities affected by these contract negotiations are located throughout Northern and Southern California and include: Santa Barbara County, San Luis Obispo County, Ventura County and Monterey County. For a complete list, please view the Provider Finder.

With the February deadline approaching, Anthem members who seek treatment from a Tenet owned facility, are encouraged to be aware of other options in their area. Although negotiations may come to a successful conclusion before the current contract expires, preparation for care from alternative facilities would be advantageous in the event of a contract termination.

Anthem members can use the Provider Finder to search for other hospitals that are in-network.

For detailed information, view Tenet Healthcare Pre-Termination FAQs.