Patient Aid Group To Receive Grant From Insurer Settlement
Department of Managed Health Care Director Cindy Ehnes today will announce a $500,000 grant for the Health Consumer Alliance, a statewide partnership of patient assistance programs that aim to help low-income residents obtain necessary medical care and avoid getting stuck with unpaid claims, the Los Angeles Times reports.
The funding comes from a fine paid by Blue Shield of California to settle an allegation that last year it consistently failed to pay claims in a timely manner for treatment that regulators required it to provide for its members.
When health plans deny treatment, patients can appeal to DMHC. Qualified appeals are sent to an outside contractor, which finds expert physicians to reassess treatment denials.
If the panel rules in the patient's favor and authorizes the treatment, the insurer is required to pay for the disputed treatment within five days.
Blue Shield spokesperson David Seldin said the health plan cooperated with the investigation and now pays for treatments on time. He added that Blue Shield was pleased the fine was going to a good cause.
The grant will be used to create a brochure explaining patient rights in 12 languages and for outreach to ensure that residents are aware of their health plan grievance and appeal rights, as well as the state's HMO Help Center (Girion, Los Angeles Times, 3/19).