latimes.com/business/la-fi-anthem-rates-20110408,0,7439995.story
Cuts to Anthem's rate hikes are not for everyone
Oversight of Anthem Blue Cross individual plans is split between two health
insurance regulators. One group is getting a break on cost increases. The other
is not.
By Duke Helfand, Los Angeles Times
April 8, 2011
Nearly 151,000 Anthem Blue Cross individual policyholders face rate hikes of
as much as 26% on May 1, even though far more Anthem individual customers are
getting a break this year.
The difference is a result of California's
two-headed health insurance bureaucracy.
About 600,000 people with Anthem
policies under the supervision of state Insurance Commissioner Dave Jones will
see smaller-than-expected increases July 1.
Anthem agreed to cut those
rate hikes to 9.1% on average, from 16.4%, amid pressure from Jones and
consumers. The Woodland Hills insurer also postponed plans to raise deductibles
and co-pays for medical care until January.
Left out were 150,983
customers with individual plans overseen by the Department of Managed Health
Care, an agency under California Gov. Jerry Brown. Anthem, the state's largest
for-profit health insurer, said it would raise rates an average of 16% for these
subscribers May 1, in addition to hiking deductibles and co-pays.
Many of
the policyholders facing bigger rate increases said they were surprised to learn
that their individual plans were regulated by the managed healthcare department.
They said they had believed — incorrectly — that they too would get a break on
rates and other costs, like most other consumers with individual policies from
Anthem.
"I feel shock and fury as much as confusion," said policyholder
Cathy Kay, 54, a healthcare attorney in Sherman Oaks.
Kay said she faces
a 17% hike as well as an increase in her deductible from $2,500 to $2,950, even
though she already met the lower deductible in January.
"Everything I
read had quotes from Blue Cross saying they were going to roll these rate
increases back," she said. "They're playing fast and loose."
The managed
healthcare department said last month that Anthem's May 1 rate changes were
vetted by an outside actuary and not found to be "unreasonable or
unjustified."
But after Anthem agreed to cut its rate hikes for the
600,000 customers under Jones' jurisdiction, the managed healthcare department
took a second look at Anthem's filing.
The department found that 121,000
of the Anthem policyholders it oversaw would be paying more for comparable
products than those overseen by Jones. The difference was three to four
percentage points for these consumers, who have preferred provider organization
policies, officials said. (The remaining 30,000 customers under the managed
healthcare department did not have comparable products.)
On Thursday, the
department asked Anthem to justify the cost differences and report back by April
25 — days before the new rates take effect.
"This is unfair to consumers,
and we're asking the plan to explain why these rates are not unreasonable or
unjustified," department spokeswoman Lynne Randolph said.
Anthem said it
had proceeded with its rate increases only after they underwent a thorough
review by the managed healthcare department and its independent
actuaries.
The company pointed out that costs are sometimes higher for
policies under the managed healthcare department because of mandates that
require policies to include extras such as maternity coverage.
Anthem
spokeswoman Kristin Binns said the company lost money on its policies with the
managed healthcare department last year and expects to do so again this year,
even with the higher rates.
"The rate increases in the individual market
are not unique to Anthem, but rather represent an economic reality faced
throughout the entire industry and reflect the fact that healthcare costs
continue to escalate faster than the growth of premiums," Binns
said.
Consumers typically do not know which regulator has jurisdiction
over their policies. Neither regulator could fully explain why some PPO policies
are overseen by one agency or the other.
Anthem member Denis Robinson
said he tried unsuccessfully to figure it out so he could complain about his May
1 rate hike of 26% and an impending increase in his deductible to $2,950 from
$2,500. "It is a maze," he said.
Consumer advocates also are puzzled. On
Thursday, the group Consumer Watchdog called on the governor to merge the two
regulators under Jones' Department of Insurance, which has a large staff of
actuaries devoted to analyzing insurance filings.
"Having two regulators
is like having two DMVs — one for cars and one for trucks," Consumer
Watchdog staff attorney Jerry Flanagan said. "The insurers take advantage of
that split by playing off the strengths and weaknesses of one regulator over the
other."
duke.helfand@latimes.com
Copyright © 2011, Los Angeles Times