About Holding Insurers Accountable
Patients deserve access to health care without unnecessary barriers from their insurance companies. But with 94% of the commercial health insurance market controlled by just six companies, health insurance companies have enormous power in California — and they increasingly use that power to deny enrollees access to care or even refuse to pay for care that’s already been delivered, all while padding their bottom lines. CHA is advocating for increased oversight and accountability to ensure commercial insurers meet their basic responsibilities to patients.
In 2023, CHA filed a lawsuit against Anthem alleging that it failed to ensure timely care for its beneficiaries. Read the latest here.
CHA also participates in the American Hospital Association’s Vitality Index, a key advocacy tool that tracks claims data. Learn more.
New Anthem Policy Driven by Profits, Not Patients
Earlier this week, CHA sent a pointed letter to the president of Anthem Blue Cross of California, calling out the insurance behemoth’s new multistate payment policy — an unjust and harmful practice that will penalize California hospitals for providing care to patients involving non-participating physicians or providers.
Anthem to Impose 10% Penalty on Hospital Claims Involving Non-Participating Providers
What’s happening: Anthem Blue Cross of California announced in a provider bulletin that, on June 1, it will implement a controversial policy that applies a 10% payment penalty on facility claims when hospitals provide care to patients involving non-participating physicians or providers.
Insurance Companies Play Blame Game, But They Have Much to Answer For
Late last month, the chief executives of some of the nation’s largest insurance companies — UnitedHealth, CVS, Cigna, Elevance, and the California Blues — trekked to Capitol Hill for a day of hearings where federal lawmakers probed one of the most pressing issues of the day: health care affordability.
National News Shines Spotlight on Horrors of Insurance Company Denials
Over the weekend, CBS News aired an important and timely segment examining the challenges millions of Americans face in accessing health care services due to insurance companies denying coverage for necessary tests and treatments.
DHCS Updates Grievance and Appeals Requirements Information
What’s happening: The California Department of Health Care Services (DHCS) has republished the State Hearing Form to include a few technical changes to All Plan Letter 21-011, which addresses grievance and appeal requirements for Medi-Cal Managed Care Plans.
Issue Brief: All Californians Deserve Timely Access to Medical Care
Current California standards require health plans to ensure that their enrollees have timely access to medical care — such as being within 15 miles or a 30-minute drive from a hospital. Unfortunately, many people covered by Medi-Cal still face significant hurdles to access care.
Key Messages: All Californians Deserve Timely Access to Medical Care
California standards that ensure timely access to care for Medi-Cal enrollees will expire in less than a year.
Creators of the Vitality Index Payer Scorecard Announce Partnership with HFMA
What’s happening: Hyve Health, the creator of the CHA-endorsed Vitality Index Payer Scorecard, has entered into a national partnership on payer accountability with the Healthcare Financial Management Association. What else to know: CHA continues to encourage members to enroll in the scorecard tool, which will provide critical information to support CHA’s advocacy to hold insurers...
Media Coverage of CHA Lawsuit Runs Statewide
What’s happening: Statewide and national media coverage of the CHA lawsuit against Anthem Blue Cross includes print articles, news videos, and mentions on local radio stations.
Hospital Association Files Lawsuit Against Anthem Blue Cross for Violating Patient Protection State Laws
SACRAMENTO (April 23, 2024) — Anthem Blue Cross, one of California’s largest health insurance companies, consistently leaves thousands of its patients stranded in hospital beds long after they have been medically cleared for discharge, a violation of California law. These victims of discharge delays are forced to stay in hospitals longer, are deprived of timely post-hospital health care services, and cause backlogs for other patients who have to wait longer for hospital beds.