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.
- read the full article in the San Francisco Chronicle