Anthem Blue Cross California

by John Hansen

What’s an EPO? That was the big question for many consumers during the 2017 Open Enrollment Period in California. It made consumers uneasy, and it caused many to switch from Anthem Blue Cross Covered California to Blue Shield Covered California.

Yes, there is a difference. Anthem stopped offering out-of-network coverage. And, for many Californian’s who want choice, they felt they would be limited by this.

Whether you go with Anthem or Blue Shield, it most often makes the most sense to stay in network. Your out-of-pocket costs remain so much lower when you stay in-network.

Anthem was losing money on their out-of-network coverage offered by their PPO’s so they made a gutsy move to switch all their individual and family plans over to EPO’s and stop offering out-of-network coverage. But they may have made a mistake.

Blue Shield of California was facing the same challenges with their PPO products, but they chose to keep offering out-of-network coverage. This was a huge ri...

By John Hansen

As a reminder, effective January 1, 2017, some consumers who have Anthem Blue Cross Covered California will have a plan change from a Preferred Provider Organization (PPO) to an Exclusive Provider Organization (EPO). Covered California consumers who were enrolled in certain Anthem Blue Cross PPO plans in regions 1 through 9 and 15 through 19 in 2016 are impacted by this change.

If you take no action to renew or change plans through Covered California, your coverage will automatically be renewed 30 days after the date on the Covered California renewal notice, into the Anthem Blue Cross EPO plan available in your area. If you want to make a change to your plan for coverage beginning January 1, 2017, a new plan must be selected by December 15, 2016.

PPO plans are the most desirable because they offer out-of-network coverage. However, they tend to be more expensive and sometimes people don’t use the out-of-network coverage enough to make it worthwhile. On a PPO, your out-o...

by John Hansen

Blue Shield of California has Sutter in their network. Anthem does not. Regarding Stanford, Anthem offers coverage through the hospital but not the medical group. Blue Shield has both.

In Santa Barbara, the Cottage Hospital and Sansum networks are with Anthem Blue Cross, but Blue Shield does not have them. Blue Shield has questioned, “Is it worth adding a network when you’d have to increase your rates in that region by 10% to do so?”

Both Anthem Blue Cross and Blue Shield of California offer Obamacare California health plans through Covered California, the state exchange. In the Health Insurance Marketplace in 2016, the top selling medical policies were the Covered California Blue Shield plans. However, in 2014 and 2015, Anthem Blue Cross Covered California plans were #1 sellers on the Covered California Exchange.

With these two health insurance California competitors, their premiums tend to be very comparable. Depending on your region, the cheapest California health p...

by John Hansen

Anthem Blue Cross and Blue Shield of California are leading the way when it comes to transparency regarding the cost of various health care procedures. They are now providing online tools where consumers can look up various health care procedures, see average costs, and view mortality rates. This helps California consumers in two primary ways.

When your doctor or surgeon tells you a procedure is going to cost X amount of dollars, you can respond intelligently. You’ll know whether or not your medical provider is offering you a reasonable price.

In the past, health plan members often took their physician’s word for it, not having any way to know whether or not the price was affordable. Now, consumers can check average costs ahead of time. They can haggle for a better price, or they can vote with their feet and go find someone who will give them an affordable price.

Mortality rates are worth checking. If you have a 15% chance of dying on the operating table, that may make...