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May 01, 2008

Cracking down on fraud in California managed health care

Are you uninsured? Unfortunately, you are not alone. In California, out of a total population of nearly 36 million people, 18.4 percent do not have health insurance coverage. Some lost their insurance when they lost their jobs. Others may be working, but their jobs don't provide health insurance benefits. Whatever the reason, finding and keeping health insurance can be difficult.

This week is Cover the Uninsured Week, a national effort to highlight the fact that too many Americans are living without health insurance and to encourage all of us to come together and seek solutions.

We know that reaching the goal of affordable and stable health care for all requires changes in public policy. Governor Schwarzenegger continues to work towards covering everyone regardless of ability to pay or preexisting health conditions. The California Department of Managed Health Care (DMHC), under his leadership, has been working to increase quality, affordable forms of comprehensive health insurance.

In the absence of successful efforts to reform our health system, however, alternatives to health insurance have cropped up in the marketplace. One is a discount health plan -- which may not be truly offer a worthwhile discount and may even be fraudulent.

The idea behind a discount health plan is a membership program which offers reduced-rate health care services to the public. These plans typically charge an annual membership fee and a monthly payment in exchange for a list of health care providers who will deliver services to members at a discounted rate. Members must then pay directly for the health services. The discount plan is not insurance; meaning that neither the plan nor any other entity assumes financial risk to pay providers for delivering services. It is more of a pay-as-you go service, but at less cost than the normal fee that an uninsured person would pay.

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Posted by healthinsurance at May 1, 2008 02:25 PM