Dispute Between California Hospital Chain, Insurer Affects Access to Care for Some Medi-Cal Beneficiaries
Some Medi-Cal beneficiaries are "getting caught in the middle" of a contract dispute over reimbursement rates between insurer Health Net Inc. and Tenet Healthcare Corp., the state's largest hospital operator, the Los Angeles Times reports. Health Net manages care for 577,000 Medi-Cal beneficiaries. As of this month, the insurer will not allow new beneficiaries that it covers to receive health services from 10 hospitals and 20 medical groups owned by Tenet as a result of the contract dispute. Health Net said that the action reduces the "risk of patient disruption if negotiations broke down and resulted in termination of contracts." Christopher Ciano, general manager of Health Net's Southern California operations, said that the action affects only 10% of hospitals and about 12% of primary care physicians in the Health Net network, adding that new beneficiaries can select from other hospitals and doctors.
Some health professionals and consumer advocates, however, said that the contract dispute has caused some beneficiaries to lose access to care in their areas. In certain parts of the state, Tenet has a "dominant market share," and Medi-Cal beneficiaries are less likely than other residents to "have transportation to see doctors farther away," the Times reports. Steven Fisher, deputy director for the Department of Managed Health Care, said that the agency would examine whether Health Net's action has "disrupted care" and whether new Medi-Cal beneficiaries have "reasonable access to providers, as is guaranteed under the [state's] patients' rights law." In addition, Fisher and Stan Rosenstein, assistant deputy director of medical services for the Department of Health Services, said both agencies would ensure that Health Net's provider directory was updated to include "any changes, so that prospective Medi-Cal members" are aware of which providers and hospitals they can visit (Lee, Los Angeles Times, 7/24).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.