Patients deserve access to health care without unnecessary barriers from their insurance companies. Paying covered, medically necessary claims on time and in full means hospitals, doctors, and other providers can focus on their primary mission — healing those who are sick and injured. 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 and 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.
Latest News
CMS Finalizes Medicare Advantage, Part D Rule for 2026
What’s happening: In its finalized changes to the Medicare Advantage (MA) and Part D prescription drug programs for contract year 2026, the Centers for Medicare & Medicaid Services (CMS) struck most of the Biden-era proposals and declined to finalize additional insurer accountability provisions.
What else to know: The rule, which did not address several other proposals (detailed below), is effective Jan. 1, 2026.
Legislation
CHA is working to hold insurers accountable for meeting their basic responsibilities to patients and providers. During the current legislative session, CHA is working with other key stakeholders to support legislative proposals that would improve patient access to medically necessary care and increase insurer and plan transparency. Priority bills CHA is supporting include AB 510, AB 512, and SB 306, which seek to implement meaningful reform to the prior authorization process, as well AB 384 and AB 669, which would address prior authorization for certain behavioral health services. CHA is also supporting SB 306 which would mandate that health plans collect and publicly report health insurance claims denial information.
CHA v. Anthem Blue Cross
In April 2024, CHA filed a lawsuit against Anthem Blue Cross, one of California’s largest health insurance companies, alleging that the insurance giant consistently leaves thousands of its patients stranded in hospital beds long after they have been medically cleared for discharge, a violation of California law.
Join the Vitality Index today!
This tool automatically draws de-identified claims and remittance information from participating hospitals without requiring additional reporting or surveys.
Resources
Insurer Accountability Resources
CHA has developed resources illustrating the challenges with insurer delays and denials, intended to support members’ work to hold insurers accountable.
Time & Distance Standards Resources
State standards that ensure timely access to care for Medi-Cal enrollees will expire in less than a year. CHA is working to ensure patient protections will be strengthened in the new standards. Learn how: