Significant Changes Occurring in Insurance, Warns Agent in Letter to the Editor

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A Southern Humboldt insurance agent, Clover Willison, offers her take on changes to insurance this year.

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Image by Deepashree S, via Wikimedia Commons

Open enrollment for individual health insurance coverage is well underway and this year, more than prior years there are significant changes occurring in the marketplace that may greatly affect many insured members. Anyone wishing to enroll in individual coverage privately or through Covered CA to receive premium assistance must do so during open enrollment. You cannot purchase coverage at any other time of the year unless you meet special enrollment requirements (i.e. birth, death, adoption, marriage, divorce, us citizenship or loss of other credible coverage). In California we have an extended open enrollment period that those residing in other states do not have. The deadline to enroll in new coverage or make changes to existing coverage and secure a January 1st effective date is December 15th. If you enroll or make changes between December 15th and January 15th you will have a February 1st effective date. Those completing enrollments or making changes between January 15th and January 31st will have a March 1st effective date. Open enrollment will close for the 2018 plan year on January 31st, 2018.

The 2018 open enrollment season brings with it many changes, perhaps the largest being the announcement that Anthem Blue Cross is withdrawing as a carrier from 16 of the 19 rating regions in California. This holds significant impact for Anthem members throughout the state. While many regions are being forced to switch to a new carrier those members residing in region 1, 7 or 10 have the option of retaining coverage. What that means in simple terms is that those members residing in the very north part of the state (Humboldt, Trinity, Mendocino, Del Norte, Lake, Siskyou, Shasta, Tehama, Glenn, Colusa, Modoc, Lassen, Plumas, Sierra, Nevada, Amador, Alpine, Calaveras, and Tuolome counties) and those in Santa Clara and the Central Valley can choose whether or not they keep their Anthem plans or switch to another carrier.

As an agent serving much of the north part of the state and a top producer with Anthem Blue Cross I feel a responsibility to share insight regarding what we expect to see with Anthem’s exit of much of the individual market. I have spent several months researching and seeking information about what was going to happen with the Anthem provider network in the year ahead. Though information was difficult to obtain and not transparent early on after the announcement I have confirmed through numerous phone calls, emails and conversations with my internal contacts at Anthem is that there will NOT be providers or a network available outside of the geographical area in which Anthem is offering coverage. For those residing in large cities this might not be such an issue however for those who reside in rural areas in the north part of the state this is a catastrophic loss. Many north state residents choose to seek care outside of the area they live in. It can be difficult to obtain an appointment with a specialist or even find a general practitioner accepting new patients. Many folks believe the care they are offered in their rural areas is inadequate, untimely or outdated. This statement is not intended to discount the medical community in our area as we have many phenomenal providers. Prior to 2018 Anthem has provided freedom of choice to travel to network providers in other regions. Most commonly I see folks traveling south to seek orthopedic, neurologic, cardiac, ENT, women’s health, pediatric and cancer related treatments. The wait locally for things like MRI’s can be several weeks and in some cases as much as a month or more. For many it is imperative to be able to seek care or second opinions from doctors at larger facilities and outside the local area. This is also something to consider if you travel frequently through the state or have children who play sports in other areas, as only emergency (life or limb threatening) care will be covered when seeing an out of network provider. Will we see the entire network disappear on January 1st, 2018? My best guess, it is not likely however I have been advised time and again that it will happen and it will happen rapidly. All that said, on a more positive note Anthem has confirmed they will maintain a contract with both UC Davis and UCSF for the 2018 plan year. As of today they will not be contracted with any of the other UC’s. Deciding whether to keep your Anthem coverage is a personal decision and not one you should take lightly. You must really consider where and how you would choose to access care if you were dealing with a major health crisis. It is important to evaluate what providers and facilities you would choose to seek treatment at. I have many clients who are in the course of life saving treatment for medical issues like cancer and organ transplant who seek care within the UC System and many of these folks are electing to maintain their Anthem coverage simply for continuity so they do not have to go through the tedious procedure of seeking new pre-authorizations and approvals.

The only other option for individual health insurance coverage in the north part of the state is Blue Shield. As an agent I am shifting the bulk of my clients over to Blue Shield to secure them a larger network as well as coverage both in and out of network. Deciding which carrier best meets the needs of an individual must be done case by case as there is no one size fits all answer for who is best. In terms of cost, Anthem remains the most cost effective option for those enrolled in Bronze level, high deductible coverage with a significant monthly savings over Blue Shield, however at the Silver level Blue Shield is more cost effective. The difference between the two carriers in terms of cost is most notable to those who purchase their plans privately without premium assistance. Those who are enrolled through Covered CA receiving premium assistance (subsidy) do not see such a striking difference in cost, although it is still there but offset or made less impactful by the premium assistance.

It should be noted that none of the above information relates to Grandfathered plans. Members on grandfathered plans will retain the same large network of providers with both in and out of network coverage they have always had. That said, last week Anthem began notifying a large volume of grandfathered members that their plans were being discontinued and they were losing coverage. It turns out that many of these letters were sent in error and the members who received these letters of termination are not actually losing coverage. Anthem is working to resolve this issue and notify members that their coverage is not at risk and that there will be no changes to those grandfathered contracts. I have confirmed this information for every single one of my grandfathered clients, no one is losing their plan. I continue to advise my clients who have maintained grandfathered coverage to continue to do so if it is within their financial means. Unfortunately, during this timeframe there were agents who did not do their homework and instead began shifting clients into non grandfathered ACA plans. If there is anything I have learned over the last 5 years since the implementation of the Affordable Care Act it is to take nothing at face value and to research and question everything.

It has come to my attention over the last few weeks that there are many agents who take a less proactive approach to the way they conduct business both in and out of our immediate area. There are agents who are responsive and do the hard work and research on the front end and those who are reactive and respond only after there is an issue. As a consumer I encourage you to consider who you trust to assist with your health insurance needs. Is the agent you are working with aware of the impact of the changes occurring in the year ahead? Do they have your best interest or their own bottom line in mind? Health insurance is a full time business. There are changes happening constantly. There are many agents out there who are simply not keeping up with the changes as they occur. I can speak personally that it is not in my best interest to move my clients to a new carrier but I am doing it any way. I am taking somewhere between a 50-70% pay cut in the year ahead. I entered this business to help people and though I feel nervous about the security of my job in the year ahead I will ALWAYS put my clients’ needs and best interest first. Humboldt and Mendocino counties have many amazing and talented health insurance agents to assist you with your needs. It is vitally important to connect with one of these agents and make sure your best interest is protected. Now is not the time to enroll directly or manage your own health insurance, nor to call an 800# and hope the person on the other end provides service after the sale. It does not cost you anything to work with an agent and in doing so you get someone who understands the lingo, has developed relationships with the carriers and knows the questions to ask as changes occur. Consider aligning yourself with someone who does the research and keeps up to date so that you don’t have to. I spend a fair amount of time answering questions and correcting issues for folks who are not my clients. I have prided myself on being available and willing to assist anyone who needs help whether I had their business or not. In order to continue to provide for both my employee and myself I need to focus on my clients and those who wish to become my clients as opposed to servicing the clients of other agents.

I realize the above is a lot of information but I felt that it was important information for people to have as they make coverage decisions for 2018. I wish to thank my clients for their dedication, support and continued business as well as the patience they have shown during this open enrollment season. If you have questions or need assistance please feel free to contact my office.

Clover Willison

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30 comments

  • Health insurance has become so incredibly convoluted that any guidance is important but I’m findinding myself being skeptical of a seller of a product combining information with a sales pitch.

    I suppose this will bring on a flurry of responses from those supporting a national health plan because it seems so simple a solution to them. They prefer having someone tell them what to do as it frees them from having to choose. Unfortunately a national health plan also frees them from having the ability to choose. Which can be fatal to those needing something different than what the government decides it can afford. Think of it as an exclusive HMO for the whole country where the government restricts your access based on what is affordable to them and restricts what providers can charge and what they can charge for. The providers have rely on volume to earn a living and we don’t have that volume. Government imposed expenses- yes but not the return on the investment that urban areas offer. And government puts in the regulations to keep you from doing an end run around their rules.

    It becomes a strangle hold on rural communities. All the insurance in the world does no good if you can’t find an adequate doctor with time to see you. When there are no choices of doctors and your doctor isn’t being effective, that can kill you even if you don’t have to pay a dime for seeing them. Politicians put the dollars where the voters are and even our own representatives don’t bother with the really rural areas in their own districts.

    It’s hard because it’s hard, not because someone else should be making it easy.

    • Very thought provoking….thank you.

    • Paperwork and Laptops

      I have already seen this “restriction of choice” in action -thanks to the ACA! There is a specialist I need to see in Eureka for a particular health problem I have. Back in the old days I would scrap together the $100 from odd jobs and go see her for an annual check-up, consultation and a strategy with meds and prescriptions. Since the ACA started up she can no longer- By Law- see me in an -out-of-pocket situation. I need to have an insurance plan that allows me to see her! And…Medi-cal forget it. Open Sore Clinic who misdiagnosed me and bullshitted me for years would let me linger away seeing many unnecessary doctors before they would ever approve of me seeing my doctor who I know helps me with my health-compromising issue. So I did what I had to- I actually lied to California Covered Care and claimed more income than I made so I could get an Anthem plan that let me see my doctor. Then I filed taxes and actually claimed MORE income than I made so I could keep my insurance plan. Yes- that’s how wonderful the ACA is for me! What used to be a simple annual office visit now costs me way more and I got to spend many hours of paperwork to get it. But hey- think of all those thousands of jobs of paper-pushers created by the ACA and CA Covered Care!

    • tired of all this

      You obviously lack understanding of universal single payer

    • “They prefer having someone tell them what to do as it frees them from having to choose.”

      Don’t be dim, that is not part of the motivation.

      “Unfortunately a national health plan also frees them from having the ability to choose.”

      For most, it offer more choice, not less.

      “The providers have rely on volume to earn a living and we don’t have that volume.”

      This is not a necessary result of single payer health care. This describes the current and past market (ie Redwood Family Practice)

      “It becomes a strangle hold on rural communities. All the insurance in the world does no good if you can’t find an adequate doctor with time to see you.”

      Which has been the case here for decades, with the private insurance industry.

      • That response in not just dim but a black hole sucking up all the illumination that there is. Of course there are people who prefer others to solve their problems for them. It’s quite commonly be called liberal. Liberals always seem to want government action to fix their problems. In fact it’s probably the definition of liberal.

        It just always fails as those with the capability find ever increasing ways to circumvent the heavy regulation while those who can’t complain about unfairness to the very entity creating the unfairness. A system designed to fail.

        Yes, locally health care has been a problem. Even before Obamacare added a few more nails to the coffin. But don’t stop thinking just because you ran into a coincidence. Noticing the coincidence is just a couple of thoughts away from understanding.

        We were in trouble for decades because our population was heavily weighted towards Medicare and Medicaid for decades, which is a liability as far as earning a living as far as doctors are concerned. And as the Obama regulations priced out more of the few employer health plans that offset the losses of public program health care, it got ever worse.

        So your solution is to make failed programs universal. Yes, dimness does abound.

      • Thank you😊

  • Thank you for the well timed information. I just recently learned that my families Anthem Blue Cross policy premium would be increasing 49% next year. I was shocked. I have switched to a Covered Ca policy and found that my premium will be 30% LESS and I upgraded from silver to gold tier with a better carrier. Open Door Member Services at Burre Center in Eureka are very helpful and will walk you through the application process.

    • I have been hearing wonderful things about Open Door’s enrollment services. I would like to offer additional information for consideration. There are many enrollment entities, often based within local clinics and community outreach organizations and they offer guidance and support to those trying to figure things out. These folks are called “navigators” and “certified enrollment counselors”. They are not agents and are not contracted by the health insurance carriers therefore they typically have limited information about the changes occurring internally with the carriers and are unaware of network issues, etc. Because they are not agents they cannot assist you with issues, pre authorizations, claims, billing, etc. for your health plan. They are certified only with CoveredCA to process enrollments. Some of these entities are also unable to help with account updates (i.e. income, address or family size changes) within the CoveredCA system. I am in no way discounting the value they bring and the guidance they offer but it is important to know that they can not “help you” with your coverage after the sale. Once they enroll you their job is done and their role fulfilled. Obviously not everyone needs or wants an agent and many are comfortable advocating for themselves. The role of a thorough full service agent is to be your go to person when you have needs arise and require help with billing issues, claims processing, obtaining pre authorizations for medical services and prescriptions, etc. I am not making a sales pitch for myself here as there are many options for local agents. I am just lending insight and clarity. It is not at all uncommon for someone to enroll through a health center and then realize mid year they need the help of an agent and at that point it is often too late. As an agent I have seen an incredible number of people enrolled improperly into the Covered CA system, many of those folks have ended up with enormous paybacks of premium assistance at the end of the tax year. In my office we spend the “off months” of the enrollment season working with clients, CoveredCA and the health carriers to correct issues and mistakes made during the enrollment process by those enrolling directly or those who received inadequate guidance. As long as a person understands the level of service they would like to have and has confidence in the person enrolling them they should be in good hands.

    • Anthem’s CEO makes $78,000 per DAY
      Still wonder why rates are so high?

  • Thank you so much for the information. I found it very helpful. We can’t afford any insurance. There’s no Doctors here,and we could never travel.

    • G-MAS Please give the Open Door at Burre Center a try.

      • Paperwork and Laptops

        Yes. They are something else. They helped me connive and lie to get MediCal but when I realized I could only go to Open Sore with MediCal then I bolted. I’d rather treat myself than have those hacks give me bad advice and waste my time. They really are terrible. Perhaps overworked or burned out? I’m trying to be generous here.

  • Bravo to Clover for her diligent research on this, and for sharing her findings with the whole community! In my personal experience, she has gone above and beyond…

  • tired of all this

    UNIVERSAL SINGLE PAYER
    MEDICARE FOR ALL
    SOLVE THE PROBLEM
    DO IT NOW
    PEOPLE ARE SUFFERING
    GOING BANKRUPT
    DYING…..

    • No it doesn’t. It just changes one problem for another. And frankly, if the government is going broke paying for waves of elderly now using it after decades of paying taxes without using it, who is going to pay for everyone using it before they contribute a dime? If they ever do.

    • So single payer huh ? To be used for check ups ? Naa insurance is supposed to cover unexpected costs, like fires etc. When i hear universal health care for all, i hear , someone needs to take money from others and pay for something idont want to spend my own money for.
      The next point is typicaly made that health care is a right . Well answer me this. What right does anyone have to tell you where or how much you have to work for ? These doctors , nurses , specialists spend many years and in some cases hundreds of thousands of their money to become such. And people think they have a right to tell them how much they can charge for their services ?
      Health care is not a right, access to it is, meaning everyone should have the right to pay for the services they require. It costs to much ? Try taking better care of yourself. Still costs to much , try asking doctors if all those tests are really needed. Or maybe take a job that offers health insurance.
      And my most hated statement is , well everyone else that is a first world natuon has health coverage, well, then i say move there, this is america , we were founded to be differant from the rest of the world. To give people a place they could fordge out a life without goverment interfearance. Stop attempting to take those rights away from others , because you were either 2 foolish , or unwilling to do what needed to be done so you could afford living longer. Back in the 1800’s people only lived to 35 or so. Be happy most live longer now. If you pissed your money away without saving or without taking care of yourself, you really dont have a right to demand anything from those of us to saved up and planned. Single payer reduces quailty of health services exchanging it for masses. You cant have your cake and eat it as well. Should have ate your veggies before thinking you deserved deseart.

  • This is what happens when the government takes over medical care. Thanks Obama.

    • Obomacare is not “government taking over medical care”. It is government forcing citizens to do business with private companies. It was a noble aim, gutted by compromise with the monied interest groups. Hard to think of anything less liberal.

      • There is a history of “noble aims” rammed through into law by liberals that created mess after mess. Look over at the thread on the Fortuna robbery that caused someone to blame Reagan for closing the mental hospitals when really he just signed off on the mess created by liberals in their desire to impose ‘noble aims’ on the public.

        Yet no matter how much reality interferes with the fantasy promulgated by liberals, somehow it is never their fault. They always blame someone else because the world does not work like they think it should.

        • The ACA (Obamacare) was created by Republicans and Mitt Romney introduced it in Massachusetts years ago. It would have worked better nationally if the public option, created by the Democrats, had been instituted instead of being removed last minute, behind closed doors, by Republicans. There would have been competition and insurance companies wouldn’t be calling all the shots.

          Reagan closed mental institutions as did most of the country. It’s one of the reasons there are so many homeless people, though Republican economic policies (trickle down) have also created many homeless as well. We will see thousands more in the future after this tax bill is passed.

          • Republicans couldn’t even get the bill in time to read it before it was sent up to vote. As Pelosi famously said, “we have to pass the bill so that you can find out what is in it, away from the fog of the controversy.”

            As for Mitt Romney being responsible, I don’t think he was ever in Congress at all.

            If you remember what happened-
            https://resources.ehealthinsurance.com/affordable-care-act/history-timeline-affordable-care-act-aca,
            ” March 11, 2010: Now lacking the 60th vote needed to pass the bill, Senate Democrats decide to use budget reconciliation in order to get to one bill approved by the House and the Senate. The use of budget reconciliation only requires 51 Senators to vote in favor of the bill in order for it to go to the president’s desk for signature.
            March 21, 2010: The Senate’s version of the health-care plan is approved by the House in a 219-212 vote. All Republicans and 34 Democrats vote against the plan.”

            Mitt Romney did do something similar for Massachusetts but it was not the bill the Democrats frog marched through Congress. No,Obamacare is all the Democrat’s illegitimate love child. Theirs and theirs alone

            And no one ever said that Reagan did not close some hospitals. He probably did, as was the Democrat’s goal in passing the law and which subsequent Democrats also did. You just can’t put the blame on him. It was Brown’s law, not Reagan’s.

    • Sure glad the government got involved in health insurance, mine has been cancelled twice and rate has Tripled since politicians decided to figure out how to get points on being re elected , now let’s make every one buy liability insurance and life insurance and auto insurance whether you own a car or not

  • I so strongly agree with Jared Rossman! As a client of Clover’s, I have gotten an amazing amount of support when issues have come up between health care providers and my insurance, leaving me in the middle, expected to pay for services that my insurance is supposed to cover, or having undergone care provider- ordered testing that simply pads my bill. Clover is being proactive, and working hard for the community, and I appreciate her thoughtfulness in providing information to the general community so that we can each make informed choices.

  • Exexperienced healthcare worker.

    This issue is way more complex than either side is willing to admit. It will continue to increase in expenses and costs because new therapies, drugs and equipment cost more than previous ones. And as we add more technology it costs more. Who do we pass the expense of better medicine on to? The taxpayer and consumer, of course. Nobody else is going to contribute to those expenses. The cost of our medical care will be paid for by our health care premiums, our deductibles, and our copays. Unless you want the government to pay for it in which case taxes will have to be raised accordingly. There is no free health care.

    • Government is already paying for it,its called subsidies, for the millions that don’t want to work one minute more than they need to, or just call them lazy free loaders

  • One part of Obamacare I thought sounded useful was the part about educating more medical personnel to meet the needs of the country. And HSU closed down its nursing degree training as too expensive. Coincidence you say. I say yes but it shouldn’t have been. It should have been the crux of the issue of health care for us. There was a place to spend money that would have done good, it’s just that doing real good for us locally did not matter.

    I know it is just one issue but it is telling about the lack of sense in modern political agendas. Here, in rural Humboldt, the State University can spend its money to increase ‘diversity’ by ‘recruiting’ students from an area 800 miles away, because of State guidelines, and that already has many more options for health care than we’ll ever see, while cutting out totally a program that both could provide jobs that are needed and supplies services that are needed and call themselves progressive and good.

    Too many grand schemes doomed to fail because the schemers can’t bother with details. Too much looking at the horizon, the long view, that they will never get to reach because they will trip over the rock in the path right under their nose. Too much time spent blaming and not enough with the hard working of doing.

  • Stage 1 Collapse

    Faith in “business as usual” is lost. The future is no longer assumed [to] resemble the past in any way that allows risk to be assessed and financial assets to be guaranteed. Financial institutions become insolvent; savings are wiped out, and access to capital is lost.

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