In Brief: Blue Shield Rate Hike Will Stand; OAL Approves Emergency Autism Regs
Blue Shield Rate Hike Will Stand
Blue Shield of California has enacted an average premium rate hike of 11.7% on 268,000 individual policyholders this month despite a declaration by California Insurance Commissioner Dave Jones that the rate hike is unreasonable.
A statement issued by the insurer, a San Francisco-based not-for-profit, said the increase was required due to continually rising healthcare costs – a trend it expects to spike upward with the nearly complete implementation of the Patient Protection and Affordable Care Act in 2014.
In some instances, policyholders will see rate hikes as high as 19.9%.
Although Jones declared the pending rate hike as unreasonable based on an actuarial analysis of Blue Shield's medical and administrative cost trends by the California Department of Insurance, he has no regulatory authority to stop it. However, his declarations on the reasonability of some rate hikes has pressured some insurers to moderate the increases, although Blue Shield did not yield in this instance.
“Every American will be required to purchase health insurance by the end of the year, but unjustified double-digit
ncreases continue unchecked because many states don't have the power to tell insurance companies no,” said Carmen Balber, executive director of Consumer Watchdog, a Santa Monica-based advocacy group that has sponsored a ballot initiative that would give the Department of Insurance and the Department of Managed Health Care power to regulate rate increases. The initiative is to be voted on next year.
Consumer Watchdog also supports federal legislation co-authored by Sen. Dianne Feinstein, D-California, to give the U.S. Department of Health and Human Services power to reject insurer premium increases if they're considered unreasonable.
OAL Approves Emergency Autism Treatment Regulations
California Insurance Commissioner Dave Jones announced earlier this week that the state's Office of Administrative Law approved emergency regulations intended to address alleged delays among autistic patients in receiving certain therapies expected to be beneficial to their condition.
The OLA approved the regulations little more than a week after the California Department of Insurance filed them with the body.
The regulations bar insurers from putting dollar amount limits on autism treatments in most instances, prohibit limits on visits to therapists, and bars delays in treatment pending testing for the cognitive levels of patients.
Jones filed the regulations after his office received numerous complaints from enrollees in health plans overseen by the DOI saying their insurers were making it difficult to obtain coverage for some autism-related therapies by their insurers. Gov. Brown signed into law in late 2011 legislation intended to address the issue.
“These emergency regulations will ensure that insurance companies cover medically necessary treatment required by the Mental Health Parity Act,” Jones said in reference to the 2011 law. “Autistic children and their families should now, without
delay, receive the transformative treatment that will enable them to succeed in school, their families, and communities.”
San Bernardino-based Inland Empire Health Plan has received an award for its work in providing insurance coverage to children.
IEHP received the Champion for Children Award from California Coverage and Health Initiatives. The award cited IEHP's initiatives to enroll kids in Healthy Families, Medi-Cal and Healthy Kids programs. It has helped 150,000 children enroll over the past decade.
“This award is a great honor because it is a testament to our team's hard work in helping families get health coverage for their children,” said Bradley Gilbert, M.D., IEHP's chief executive officer.
