Los Angeles Times Examines Changes in Health Care Policies
In today's health section, Los Angeles Times health columnist Bob Rosenblatt outlines changes to the state's health care policies that took effect at the beginning of the year:
- Denial of care. California law now allows patients denied a "treatment, procedure or referral" by an HMO to appeal the decision. If the HMO denies an initial appeal, patients have the right to a review from "independent doctors" not affiliated with the HMO. Appeals will be handled by the Department of Managed Health Care;
- Medicare HMO pullouts. Patients have several options if their Medicare HMO leaves their market, including enrolling in a traditional fee-for-service Medicare program or joining another HMO. Patients also can consider joining a Medicare HMO that has their current doctor as a member;
- Retirement health benefits. California now allows people enrolled in Medicare to purchase Medi-gap insurance at any age of retirement. Previously, consumers were required to purchase the additional coverage within six months of turning 65;
Medi-Cal benefits. California raised the "countable" income requirements for Medi-Cal to $926 per month for a single person and $1,248 a month for a couple after "various exclusions" are taken;
- Disability insurance. New Medicare policies allow those with disabilities access to "specific" Medi-gap policies if purchased by April 30. Applicants cannot be rejected or subjected to higher costs because of preexisting conditions;
- Pregnancy and adoption coverage. Pregnant women can sign up for health insurance outside the open enrollment period. Women giving birth or those adopting a child can enroll in a plan within 30 days of the birth or adoption. The policy is guaranteed under the federal Health Insurance Portability and Accountability Act;
- Childhood vaccinations. The full cost of children's vaccines will be paid to doctors, even though the reimbursement may not yet be covered by the insurance company or HMO;
- Breast cancer. A federal government campaign is reminding consumers of the protections under the Women's Health and Cancer Rights Act (HR 383). Under that law, if a health plan covers a mastectomy, it must also cover reconstruction of the breast, surgery to assure symmetrical balance between the breasts and a prosthesis, if needed; and
- Uninsured cancer treatment. Medi-Cal now is required to cover the full cost of treatments for breast and cervical cancer for women who lack health insurance and earn less than 250% of the federal poverty level. To qualify for care, the cancer must be detected through the free screening program run by the CDC, which is available at community health centers and hospitals.
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.