Health Net to rescind recently announced payment policies Since Health Net first notified physicians in March of planned changes to its modifier 25 and emergency services payment policies for Medicare and Medi-Cal lines of business, the California Medical Association (CMA) has been working to educate the payor about physician concerns with the new policies. Last month Health Net agreed to delay implementation of the new policies until July 1, 2018, to allow time to review provider concerns with the new policies and to continue discussions with CMA and other stakeholders. “We believe a more collaborative approach to identify alternative ... July 13, 2018 Coding, General, Health Net, Insurance 0 0 Comment Read More »
CMA survey finds rampant health plan payment abuses Despite a California law passed in 2000 to address widespread payment abuses by health care service plans, many payors continue to flout the law. A recent survey by the California Medical Association (CMA) confirms that health plans regularly engage in unfair payment practices, with two-thirds of physician practices reporting routine payment abuses in violation of state law. The Department of Managed Health Care (DMHC) has been slow to address provider complaints and has taken few enforcement actions against health plans that unlawfully underpay providers. When DMHC has acted, the penalty ... April 10, 2018 DMHC, Insurance Department of Managed Healthcare, DMHC, unfair payment practices 0 0 Comment Read More »
Raise taxes or ration health care? Why single-payer won't work in California. Yet Betty Doumas-Toto's health insurance premium rose nearly 48 percent in January, to $800 per month for an Affordable Care Act plan. She and her husband are both Los Angeles freelancers in the film industry and are draining their savings trying to keep up with their monthly payments. A Pomona mother of five named Claudia, who is undocumented, can't get health insurance because of her immigration status. She's losing her hearing, but can't afford tests a doctor ordered because the costs are too high. At an elder care home in the Sacramento ... March 13, 2018 Insurance 0 0 Comment Read More »
Anthem Calls On Eye Surgeons To Monitor Anesthesia During Cataract Surgery If you need cataract surgery, your eye surgeon may have to do double duty as your anesthetist under a new policy by health insurer Anthem. In a clinical guideline released this month, the company said it’s not medically necessary to have an anesthesiologist or nurse anesthetist on hand to administer and monitor sedation in most cases. Read More February 21, 2018 Anthem, Blue Cross, Insurance 0 0 Comment Read More »
California’s Regulators To Investigate Aetna’s Medical Coverage Decisions Both of California’s health insurance regulators said they will investigate how Aetna Inc. makes coverage decisions, as the lawsuit of a California man who is suing the nation’s third-largest insurer for improper denial of care heads for opening arguments on Wednesday. The Department of Managed Health Care, which regulates the vast majority of health plans in California, said Monday it will investigate Hartford, Ct.-based Aetna after CNN first reported Sunday that one of the company’s medical directors had testified in a deposition related to the lawsuit that he did not examine patients’ records before ... February 20, 2018 Aetna, Insurance 0 0 Comment Read More »
