“‘Fingers crossed’ that I haven’t authorized something the FTC will hunt me down for,” a staffer wrote after destroying the documents. Sutter, a huge Northern California Health system with 24 hospitals, said it destroyed them by mistake.
The Department of Managed Health Care cited one example in which consumers and advocates had to call the insurer 22 times to contest a decision. Still, the complaint still was not resolved until the department became involved.
State regulators and insurers are looking into SynerMed, which medical groups depend upon to handle their finances and business operations. The groups, serving 1 million patients, fear a messy fallout.
Medicaid is rarely associated with getting rich. But some insurance companies are reaping spectacular profits off the taxpayer-funded program in California, even when the state finds their patient care is subpar.
UnitedHealth, a health industry goliath, has its hand in doctors’ offices, surgery centers, technology services and prescription drugs. It is the industry model, and CVS and Aetna, says one expert, are ‘wannabes.’
The president’s move to end payments that reduce out-of-pocket costs for low-income consumers had already been anticipated in California and some other states — and could hit a legal snag.
After regulators questioned Anthem’s forecast for medical costs, the company agreed to reduce rate hikes on its individual and small-business health plans next year, saving customers an estimated $114 million.
Covered California authorized a 12.4 percent average surcharge on silver-tier plans, the second-least expensive option sold on the exchange. It brings the total average premium increase on those plans to nearly 25 percent next year.
Agency says a removable cap will lower the risk of antibiotic resistant infections but some experts see it as a modest step in curbing the sort of deadly outbreaks that occurred a few years ago.
The company’s drug spending prediction, far above other insurers in the individual market, has experts scratching their heads. Anthem cites market volatility.