DMHC Helped 200,000 HMO Patients in 2001, Davis Says
The Department of Managed Health Care helped 200,000 HMO patients resolve disputes with their health plans in 2001, Gov. Gray Davis (D) announced last week. The Sacramento Bee reports that the "controversial" department, established in July 2000 as part of Davis' managed care reform plan, was created to "make health plans more accountable" for denials or delays of care. Patients can call DMHC's HMO help center to receive contact information for health plans. In addition, the DMHC helps patients file formal complaints against their HMOs and offers patients access to an independent medical review "if they disagree with a treatment decision made by an HMO." The state conducted 549 independent medical reviews between January and November 2001. Reviewers upheld the decisions of health plans in 317 cases and ruled against HMOs in 189 cases. Patients dropped 43 cases after health plans reversed their decisions to deny care. "The HMO help center is not only helping people avoid bureaucratic hassles during a serious help crisis, it's guaranteeing they get quality health care," Davis said (Rapaport, Sacramento Bee, 12/29/01).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.