DMHC Not Listening to Complaints?

What if you gave a legislative oversight hearing, and the object of that hearing didn’t show up?

That was the case last week, when the Budget Subcommittee on Health and Human Services conducted an oversight hearing to deal with complaints about the Department of Managed Health Care. Emergency department officials, who feel they’ve been grossly and routinely underpaid by some insurance organizations, say the DMHC is supposed to adjudicate those conflicts, but has instead been ignoring them.

“This is extraordinarily disrespectful. I’m extraordinarily displeased they decided not to participate,” Assembly member Dave Jones (D-Sacramento) said.

“I have been in this Legislature for six years now, but I have yet to see a circumstance where senior officials of an administration refuse to participate in a legislative oversight hearing, as was the case here,” said Jones, the newly elected insurance commissioner of California.

An official at the Department of Managed Health Care who spoke on background said the department needs time to work out answers to some of the complaints that have been raised, and it hopes to meet with the subcommittee in January.

When Jones learned from the governor’s office that DMHC officials would not be able to attend, he tried to reschedule the hearing but Jones said he was refused.

To emergency physician Michael Forman, who flew in from Oceanside, near San Diego, this was par for the course.

“We all complain and we get no response,” Forman said. “As insurance companies get more brazen and pay us less and less, the ability to have a small-business model is getting worse and worse. When we don’t get paid, we have to make the staff skimpier and skimpier, so patients have to wait and wait.”

According to Andrea Brault, a physician representing the state chapter of the American College of Emergency Physicians, most of the HMOs are pretty good about emergency department payments, but some of the delegated payer models routinely down-code procedures, she said, or don’t pay at all.

“It’s at this level that we’re having tremendous difficulty,” Brault said.

Jones is drafting a letter to the DMHC. When he takes over as insurance commissioner in January, he said he expects to be dealing with that agency on a regular basis.

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