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Sutter Health Destroys Evidence In Antitrust Case

LA Times is reporting that health giant Sutter intentionally destroyed 192 boxes of documents that were being sought in a lawsuit.

The lawsuit accuses Sutter of abusing its market power and charging inflated prices.

I’ve pushed the button … I’m running and hiding. … ‘Fingers crossed’ that I haven’t authorized something the FTC will hunt me down for.
— Sina Santagata, Sutter executive assistant
The United Food and Commercial Workers and its Employers Benefit Trust initially filed the case against Sutter in 2014.

Read the full LA Times Article



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HealthNet Traditional PPO & EnhancedCare PPO For California 2018

When it comes to HealthNet individual & family health plans, things can get a little tricky.

HealthNet has offered their traditional PPO plan in selected areas of California for a few years now.  This PPO is a broad-network plan.  In areas where it is available, the network exceeds that or competitor Blue Shield.  The new EnhancedCare PPO is a smaller network PPO plan introduced in certain regions for 2018.

In 2018, HealthNet has made some changes so I want to cover them here.

Traditional PPO (off exchange only)
HealthNet's traditional individual & family PPO plan for 2018 will be available in the following regions:

Region 2  Marin, Napa, Solano, and Sonoma counties
Region 4  San Francisco County
Region 5  Contra Costa County
Region 7  Santa Clara County
Region 8  San Mateo County
Region 9  Santa Cruz County
Region 10 Merced, San Joaquin, Stanislaus, and Tulare counties
Region 14 Kern County (partial)
Region 15 Los Angeles County: ZIP codes starting with 906-912, 915, 917, 918, 935

Dept of Managed Health Care Fines Anthem $5 Million

According to Kaiser Health News, the California Department of Managed Health Care (DMHC) has fined Anthem 5 million dollars for failure to address member grievances.  

According to DMHC, between 2013 and 2016, it (DMHC) identified 245 grievance-system violations by Anthem.  

Rouillard cited one example in which Anthem denied a submitted claim for an extensive surgical procedure, even though it had issued prior approval for the operation. Twenty-two calls contesting the denial — placed by the patient, the patient’s spouse, the couple’s insurance broker and the medical provider — failed to resolve the complaint. It was not until the patient sought help from the managed-care agency, more than six months after the treatment, that Anthem paid the claim.
Read the full article at KHN



California Silver Plans Cheaper Off Exchange in 2018

Rates are now live for California ObamaCare 2018 health insurance plans.

Silver Plans on the marketplace experienced an additional premium rate increase.  This increase is to compensate for the loss of CSR (Cost Share Reduction) subsidy funds from the federal government.  

Those who receive tax credit subsidy (and cost share subsidy) will generally not experience any substantial premium increase for 2018.  

Those who are not eligible for subsidies and want a to enroll in a Silver plan would be better served purchasing coverage in the private market.

An example I ran on myself aged 58, Santa Clara County:

Blue Shield Silver 70 PPO Covered CA $1,298
Blue Shield Silver 70 PPO Off Exchange $1,198 (save $1200/yr premium)

Anthem Blue Cross Silver 70 EPO Covered CA $1,066
Anthem Blue Cross Silver 70 EPO Off Exchange $1,021 (save $540/yr premium)


California Obamacare Quoting Goes Live Tonight At 9 PM (PST)

I have been informed online instant quotes for 2018 ACA California health insurance plans will be live tonight beginning 9 PM PST.  For both agents and consumers, this will be our first comprehensive look at plan choices and rates.  

Take a spin to the link below and 'shop til you drop' for your complimentary quote.  Think of it as "Black Tuesday" for California health insurance.  Quoting both Marketplace (Covered CA) and off-exchange plans.  

Get My Quote Now


Unintended CSR Consequences? Super Cheap CA Bronze Plans for 2018?

With the removal of the cost share reduction subsidies by the federal government, and the resultant additional silver premium changes to cover the CSR in 2018, some interesting results are found on Covered CA (and likely all marketplaces).  

Quick Primer.  CSR (cost share reduction) subsidy is the subsidy used to reduce the share of cost on a silver health plan.  These are known as enhanced silver plans and the CSR helps reduce things like copays, deductible, out of pocket annual max and drug costs.  CSR is available to adults wit incomes in between 138%-250% federal poverty level.  These enhanced silver plans are expressed as Silver 73, Silver 87 and Silver 94.  Which one you qualify for depends on income level.

Note: families with children under 19 years of age can qualify for enhanced silver in California.  However, the children under 19 will not be entitled to enroll  in the enhanced silver plan with their parents  The income level for Medi-Cal (California Medicaid) is raised to 266…

Direct Primary Care A Growing Market Under ObamaCare/TrumpCare

Direct Primary Care, also known as 'concierge medicine', is gaining traction across the country.  DPC is primary medical care without insurance or other third party payer,

Direct primary care is essentially becoming a member of a primary care doctor's practice.  Monthly membership fees are reasonable and may include certain services at little or no additional cost.  

DPC doctors normally feature transparent pricing for services they provide.  Often services include telemedicine (Skype, e-mail, etc,,), longer and more thorough office visits and may even include house calls.  

Coupling a DPC membership with a lower cost, high deductible health insurance plan can provide for comprehensive coverage and lower premium costs.  This can also be used with a MedicaidPlus strategy (I will cover this in a future blog) to create even more premium savings.  

While expansion of DPC providers continues, there are still areas where no DPC providers are nearby.  For Santa Clara County residents…