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Anthem Data Breach: up to 80 million subscribers affected

Last night, we became aware that Anthem, Inc., the parent company of Anthem Blue Cross, is the victim of a highly-sophisticated cyber attack. Anthem has informed us that its member data was accessed, and information about our clients could be among the data.

We are working closely with Anthem to better understand the impact on its members. Here is what we do know:

  • Once Anthem determined it was the victim of a sophisticated cyber attack, it immediately notified federal law enforcement officials and shared the indicators of compromise with the HITRUST C3 (Cyber Threat Intelligence and Incident Coordination Center).
  • Anthem’s Information Security has worked to eliminate any further vulnerability and continues to secure all of its data.
  • Anthem immediately began a forensic Information Technology (IT) investigation to determine the number of impacted consumers and to identify the type of information accessed. The investigation is still taking place.
  • The information accessed includes member names, member health ID numbers/Social Security numbers, dates of birth, addresses, phone numbers, email addresses and employment information, including income data. Social Security numbers were included in only a subset of the universe of consumers that were impacted.
  • Anthem is still working to determine which members’ Social Security numbers were accessed.
  • Anthem’s investigation to date shows that no credit card or confidential health information was accessed.
  • Anthem has advised us there is no indication at this time that any of our clients’ personal information has been misused.
  • All impacted Anthem members will be enrolled in identity repair services. In addition, impacted members will be provided information on how to enroll in free credit monitoring.

Anthem has created a website –, and a hotline, 1-877-263-7995, for its members to call for more information, and has shared these Frequently Asked Questions (FAQs) that further explains the cyber attack.

Independently reporting on the story: USA Today, LA Times, SF Gate, Wired and CNN.

Sigh of Relief: Blue Shield of CA and Sutter Health sign two-year agreement

After a month of uncertainty, Blue Shield of CA subscribers were relieved to hear that the two health care giants negotiated an extension of their current network agreement through the end of 2016.

This is great news for our small group and individual clients – both on- and off-exchange, for all Blue Shield PPO, EPO, and HMO plans.

Blue Shield press release

Blue Shield FAQ’s

Sutter Health letter to patients

Sutter Health FAQ’s

Progress or stalemate? Blue Shield of CA and Sutter Health issue dual press releases offering contract extensions

It is unclear whether the press releases from yesterday and today are a sign that consumers will soon benefit from a new compromise, or if both mega-health entities are digging in for the long haul, trying to position the other as the “bad guy.”

January 2oth – Sutter Health press release

Here, Sutter proposes extending the transition period from June 30th to the end of the year.  And makes an excellent point that echoes the concerns of many of our clients:

Blue Shield sold health plan products during the fall open-enrollment period that featured the doctors and hospitals of Sutter Health; and then just days into the New Year abruptly announced plans to reassign tens of thousands of members to non-Sutter doctors.

Note that Sutter has not agreed to simply extend the 2014 contract, rather it is the transition period (in which Sutter is permitted to charge higher rates, most likely to be borne by the patient) that they are willing to extend.

Today, Blue Shield said they wanted to “set the record straight” and issued their own press release, stating they have offered Sutter Health a two-year extension of the previous contract.  And they didn’t pull any punches in their evaluation of Sutter’s proposal from yesterday:

Sutter’s January 20th proposal was not a contract extension. Under their proposal, Sutter would have the ability to increase their charges at will.

Prelude to a compromise?  Or will they both dig their heels in harder, leaving patients in the middle?  Stay tuned.

Is Covered California limiting your choices and access? State exchange rejects United Healthcare

The LA Times reports that Covered CA rejected insurance giant United Healthcare’s bid to return to the California individual market in 2016, potentially reducing competition and access to more providers. Insurance Commissioner Dave Jones disagreed with the decision.

“Covered California’s decision to substantially restrict where new health insurers can sell in 2016 protects the big health insurers’ market share and hurts consumers by denying them additional choices,” Jones said. The exchange “ought to be encouraging, not discouraging, new insurers to come in.”

In addition to securing lower rates, Jones pointed out that adding health plans could offer consumers a wider choice of doctors and medical networks. Many Californians have expressed dissatisfaction with the limited number of doctors and hospitals on some Obamacare plans.

In a market with rapidly shrinking networks, rising premiums, and fewer carrier choices, I have to agree with the commish on this one.

Breaking news: Blue Shield of CA terminates network agreement with Sutter Health

Late this afternoon, without warning, Blue Shield notified brokers and employers by email at the same time (it is unclear if they have notified individual and family subscribers directly): negotiations to renew their network contracts with Sutter Health for 2015 ended unsuccessfully. All lines of coverage are affected:

• Individual and Family Plans: Grandfathered and Non-Grandfathered PPO and EPO Plans (on and off Exchange)
• Medicare: Group Medicare Advantage Prescription Drug (GMAPD) Plans
• Small Business (1-50 employees): PPO and HMO
• Fully Funded Large Employers (51+ employees): PPO, HMO, POS-HMO Tier, POS-PPO Tier
• Self-Funded/ASO Large Employers (51+ employees): PPO and EPO
• CalPERS: HMO and EPO

Read the full notice here.

This is particularly shocking for San Francisco individual and family plan subscribers. The UC Hospital system was already out of network for Blue Shield individual and family plan networks. Many clients chose Blue Shield specifically as an affordable option to access Sutter Health providers and facilities, including the California Pacific Medical Centers and Palo Alto Medical Foundation.

Blue Shield and Sutter have agreed to a 6-month transition of care period for PPO members. This is a stopgap solution, and PPO clients should be aware that while Blue Shield will treat services rendered as in-network, they cannot prevent Sutter Health from balance-billing the patient for the higher costs no longer covered by Blue Shield.  Note that this transitional period may not apply to Blue Shield EPO members.  Please review the fact sheet for details on transition of care for all plan types.

Allpointe is here to support all of our clients in determining the best course of action for your family or small business.  Our immediate recommendations:

1. Be (somewhat) patient.  This news is hours old, and we expect to hear additional information, and perhaps clarifications/amendments in the next 72 hours.

2. Prepare to review your options. Individuals and families are still within the current open enrollment period, and may elect to change plans February 1 or March 1. Small businesses may choose to change carriers on the first of any month.

3. Stay tuned. Watch your email, and consider bookmarking Allpointe’s blog, or liking our Facebook page for future updates and recommendations.



Cigna’s pre-ACA plans to end December 31, 2014

These plan cancellations were not unexpected, though there was a chance the State of California might have allowed Cigna to extend this plan into 2015, as many other states did.  Recently, it was confirmed that California has elected to require Cigna to only offer new, ACA-compliant plans in 2015.

Locking in Cigna’s 2013 plan rates and large PPO provider network was a key part of my recommended strategy in late 2013.  As most other carriers pared down their networks, we heard numerous complaints throughout this year from clients who chose to go with Blue Shield and Anthem Blue Cross. In 2015, Health Net and Cigna will also offer smaller networks of providers.

In 2015, the one carrier that will offer a full PPO network for individuals and families, is Assurant Health.  This company has been around for 120 years and is now making a push to gain market share in California.  They have three additional years remaining in their contract with Aetna, to offer Aetna’s large Signature Administrators PPO network to Assurant Health plan customers.  For our clients to whom access to the most (and some of the best) doctors and hospitals is paramount, Assurant will be worth a look in 2015.  For those looking to keep their monthly premiums as low as possible, we will need to look carefully at the smaller provider networks before making the best choice for coverage.

Health Net Slashes the Number of Providers Available in Covered CA Plans

Although Health Net will not release their new EPO network provider list to the public until they receive regulatory approval, we have heard from insiders that the following key medical groups and facilities will NOT be part of Health Net’s EPO network in 2015:

  • UC Medical Groups
  • Palo Alto Medical Foundation, PAMF – Mills Peninsula Medical Group
  • Sutter Health and Sutter Health Affiliates
  • Brown and Toland Medical Group
  • California Pacific Medical Center (CPMC)

Note that consumers who purchase a Health Net plan directly in 2015 will get access to their full PPO network, but those who purchase individual plans through Covered CA will only get access to a very limited EPO network in Northern California.  Small businesses purchasing coverage through the Covered CA SHOP will have access to both Health Net EPO and some PPO plans.

Our frank assessment of this news is that there is no possible reason to choose Health Net if you are are Northern California resident purchasing coverage through the Covered California exchange.  Anthem and Blue Shield both have their network limitations, but both will offer larger networks and more choice than Health Net, and at lower rates in 2015.

Covered California: Extended Support Hours

After a rough start to the initial open enrollment period in late 2013 and early 2014, we found that Covered California’s call center significantly improved its service and its wait times.

Covered California has reportedly doubled the number of service center representatives as we head into open enrollment for 2015, and will offer extended service hours when you call the service center at 1-800-300-1506.

Mon-Fri: 8:00am to 8:00pm

Saturdays: 8:00am to 6:00pm

Sundays: 8:00am to 6:00pm (during initial open enrollment period 11/15/14 – 12/15/14 only)

The service center representatives can be very helpful answering routine questions and resolving technical problems with your Covered California account and application.  Please always feel free to contact Allpointe, especially for complicated questions, or if Covered CA can’t resolve your issue.  But we do encourage you to take advantage of their expertise, especially if their evening or weekend hours are more convenient for you.