California providers, carriers spar with patients over access

Carriers and patients are at odds over what treatments and procedures are medically appropriate, and why access is denied in some cases and not in others. Patients in California are finding themselves in the precarious position of having to fight for access to services they assumed were covered. The state has established patient and consumer advocacy services to address the growing problem. Last year, the state's HMO Help Center received nearly 90,000 calls from consumers asking for help in resolving their health plan woes. About 7,000 Californians have taken advantage of third-party medical reviews since 2001, when the state Department of Managed Health Care started offering them. Last year, the department resolved 1,716 independent medical review, or IMR, cases. The Department of Insurance, which regulates a smaller number of plans, received 35,280 complaints and resolved 262 IMRs in 2007. 

For more:
- read the full article in the San Francisco Chronicle

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.