What's New?
You are probably all shocked to be receiving another newsletter so soon. What can I say? The main impetus for writing is to tell Blue Cross and Health Net members about the rate increases that go into effect on August 1st. If you are not a Blue Cross member, please read the sections about claims and Canadian drug companies. I have concluded that many of you are unfamiliar with all the mechanics and benefits of your plans.

Now that I have gotten your attention, I want to tell you that I am now the proud owner of my very own web site, www.cjbconsulting.net. From my web site, you can access a description of your plan's benefits. For example, if you want a quote for group life insurance, you can download a census form and get the ball rolling. My web site is a great way to introduce your friends and family to the services I offer. And, while my site affords clients the opportunity to apply online for some plans, I strongly recommend you speak with me first.

I am very happy with the service I received from my Web Designer, Bruce Linde, at http://www.5happy.com. I have been thinking about getting a web site for a long time. Bruce made it a reality and offered great strategic suggestions as well.

Please notify me via e-mail if you'd like to receive future newsletters by e-mail.

Rate increases
So, what's the deal with these rate increases? I wish I had greater insight, but I don't. As I commented in March, the increases are the result of the complex relationship between insurance carriers, medical providers, drug companies (please read my section on drugs from Canada below), and the consumer. If you would like to review the March newsletter, it is posted on my web site at www.cjbconsulting.net.

Blue Cross
I know that you are tired of hearing about rate increases. To add to this, I feel obliged to tell you that the copayment increase from 25% to 30% which was to go into effect in February and then in April is going into effect on August 1st for those members on the PPO Share 500 and PPO Share 1000 plans. Those of you on the PPO Share 1500, 2500 and 5000 plans still have the 25% copayment. I realize this is confusing. The bottom line is that you should read the information that has been sent by Blue Cross and/or call me to confirm the specifics about your plan.

I am happy to discuss different plans and carriers and find the best plan for your needs. I find that Blue Cross premiums are comparable to their competitors. Health Net is increasing premiums; PacifiCare does not offer a PPO individual plan; Blue Shield plans are generally more expensive. The Preferred Savings Plan with Blue Shield may be an option, especially if the concept of an MSA (Medical Savings Account) is appealing.

The wildcard is the plans offered by Nationwide. At this time, I offer Nationwide plans with a disclaimer. About a year ago, the company went through a period of drastic rate increases and plan changes, so I stopped selling the plans. I have recently spoken with Nationwide management and I think they may have gotten things worked out. I have been told there will be no rate increases or plan changes for the remainder of this year. I am happy to discuss Nationwide with you or to send you information, but I want to make it clear that I don't have the same experience with them as I do with the other carriers.

Blue Shield
Blue Shield is already saving money by distinguishing between Choice and Affiliated hospitals. It is expected that medical groups and individual providers will also be categorized as either Choice or Affiliated. I will let you know when this happens.

I think that the Preferred Savings Plan is still the best MSA eligible plan available in California.

If you are unfamiliar with the Lifepath benefit, please call me for a booklet or access Blue Shield directly by web site (www.mylifepath.com). Lifepath offers discounts to many providers like acupuncturists and chiropractors. There are even discounts for yoga classes and health spas!

Canadian Drug Companies
A client recently had a prescription for Spironolacone (a blood pressure medication) filled in Canada for a fraction of the cost here in California. A 30-day supply was going to cost her $80, so she went online to the web site www.canadianmedsusa.com and purchased a 4-month supply for $30 plus $10 shipping. This is not an endorsement, but I wanted to pass this story on. At the site, you may check available medications and get pricing.

Surrogate Participants
Please, promptly forward premium statements to the appropriate party so that your coverage is not canceled.

Claims 101
If you see a medical provider who does not bill insurance, then you will be expected to pay for the service up front and submit the claim for reimbursement. Before you leave the provider's office, make sure you receive a "superbill". A superbill should have all pertinent information including the diagnosis and procedure codes. You mail the superbill along with a claim form to your insurance company. Please make copies of everything you send. If you need claim forms, let me know.

When you see a provider who does bill insurance, try to with- hold payment until you receive the Explanation of Benefits form from your insurance carrier--especially if you have seen a provider that is contracted with your insurance company. The Explanation of Benefits shows that the claim was processed. It notes the date of service, provider's name, diagnosis code, procedure code etc. It also lists the amount the insurance company was billed, the amount that is the member's responsibility and the amount that the provider might have to write off as uncollectible. If the provider tries to bill you for an amount that the insurance company has stated is not your responsibility, you do not have to pay it.

Sometimes claims are not paid simply because there is a problem with the superbill or claim form. If a claim is denied, don't panic--just inquire about the reason. If the reason is unacceptable or you need assistance, I am more than happy to help you.

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