Silicon Valley/San Jose Business Journal Examines State’s Independent Medical Review System
The Silicon Valley/San Jose Business Journal last Friday examined the low participation rate in the state's independent medical review system and profiled new efforts by the Department of Managed Health Care to increase participation (May, Silicon Valley/San Jose Business Journal, 6/28). Under California law, managed care patients have the right to an independent medical review in disputes with their health plans over treatment denials. Health plans cover the cost of the reviews, which can range from $395 to $25,000 (California Healthline, 8/6/01). The state established the system in January 2000 to reduce health care costs by "resolving medical issues out of court while still providing a place for employers to refer patients who have problems obtaining care." However, only .0028% of the 23 million state residents enrolled in managed care plans have asked for an independent medical review, and health plans have won "more than half of those disputes," the Business Journal reports. Although some observers say the "numbers are low because HMOs are denying care less often," others say few managed care patients ask for an independent review "because they are unaware it exists, or they are intimidated by the idea." In response, the DMHC has sent letters to 100 medical groups, 250 consumer organizations, 75 medical and health associations, 55 treatment facilities and a number of lawmakers statewide to help inform residents about the independent review system. The department also has a help center and a Web site that provide information about the system. The help center, which opened in July 2000, has received about 250,000 calls over the past two years, according to the DMHC (Silicon Valley/San Jose Business Journal, 6/28).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.