Holding Insurers Accountable

About Holding Insurers Accountable

Health insurance companies have enormous power in California. In fact, 94% of the commercial health insurance market is controlled by just six companies. They are increasingly denying enrollees access to care, and even refusing to pay for care that’s already been delivered, all while enjoying record profits. According to the federal government, some insurance companies are denying more than a quarter of Medicaid managed care requests. CHA is working to hold insurers accountable for meeting their basic responsibilities to patients and advocating for increased oversight and accountability for insurance companies.

DMHC Provides Overview of Complaint and Appeals Process

What’s happening: A recording of the March 26 Department of Managed Health Care (DMHC) Complaint and Appeals Process Webinar is now available.     

What else to know: This complimentary, members-only webinar includes information about DMHC’s role in the independent medical review and complaint process. DMHC staff provided an overview of their jurisdiction and the consumer and provider complaint processes.  

CHA to Host DMHC Complaint and Appeals Process Webinar

This post has been archived and contains information that may be out of date.

What’s happening: CHA is hosting the Department of Managed Health Care (DMHC) Complaint and Appeals Process Webinar on March 26 at 9 a.m. (PT).  

What else to know: This complimentary, members-only webinar will help attendees better understand DMHC’s role in the independent medical review and complaint process. Registration is open.  

Hospital Leaders Discuss Insurers’ Harmful Practices with Health Secretary 

What’s happening: On March 20, CHA convened a small group of hospital leaders for an in-depth discussion in southern California — led by CHA President & CEO Carmela Coyle — with state Health Secretary Mark Ghaly, MD, MPH. In the meeting, they had the opportunity to share perspectives on how harmful insurance practices are impeding patient care and threatening hospitals’ ability to provide care. This is part of CHA’s focus on holding insurance companies operating in California accountable for protecting patients and the providers who care for them

What else to know: Hospital leaders attending the meeting were: Laureen Driscoll, division chief executive, Providence South Division, Providence; Lori Morgan, MD, MBA, President & CEO, Huntington Health, Roger Sharma, President & CEO, Emanate; Julie Sprengel, California division president, CommonSpirit Health; and Doug Sturnick, senior vice president, Managed Care and Payer Relations, Cedars-Sinai. Joining by phone were the Health and Human Services assistant secretary and heads of the Department of Health Care Services and Department of Managed Health Care. 

CHA Participates in DHCS Population Health Management Summit

What’s happening: CHA recently participated in the Population Health Management Transitional Care Services Summit hosted by the Department of Health Care Services. 

What else to know: The summit provided an opportunity for Medi-Cal Managed Care leaders to provide updates on the implementation of transitional care services and share best practices. Several panels included representatives from CHA member hospitals, including Watsonville Community Hospital, Dignity Health, and the University of California, San Francisco.

CHA Encourages Members to Participate in the Vitality Index Payer Scorecard

What’s happening: CHA is endorsing member participation in the Vitality Index Payer Scorecard, which will provide critical information to support CHA’s advocacy to hold insurers accountable for timely and accurate reimbursement.  

What else to know: The CHA Board of Trustees has endorsed this tool, which will automatically draw de-identified claims and remittance information from hospitals without requiring additional reporting or surveys.  

CHA Opinion Piece Shines Light on Insurer Crisis in Orange County

What’s happening: CHA President & CEO Carmela Coyle shares how vulnerable Californians in Orange County are losing access to health care because an insurance company is dropping safety-net hospitals.  

What else to know: CalOptima has dropped from its network four hospitals that serve people experiencing homelessness, substance abuse disorders, chronic health conditions, and more. CHA is calling for regulators to take action to preserve health care access for California’s most vulnerable patients.   

CMS Provides “Two-Midnight Rule” Guidance for Medicare Advantage Plans

What’s happening: The Centers for Medicare & Medicaid Services (CMS) issued a frequently asked questions (FAQ) document on finalized contract year 2024 Medicare Advantage (MA) policies.   

What else to know: The document provides guidance on how the “two-midnight” hospital admissions policies apply to MA patients when MA organizations are permitted to deny payment through post-claim audits.