When a health insurance company denies a claim or refuses to authorize medically necessary care, California patients have an important protection: the right to challenge that decision through the health plan’s grievance and appeal system. That process is supposed to give the insurer an opportunity to reconsider its decision and correct mistakes before the... Read More »
The treatment of obesity has changed dramatically over the past few years. Medications once viewed primarily as tools for weight management are now recognized as important therapies for chronic diseases linked to obesity, including type 2 diabetes, cardiovascular disease, obstructive sleep apnea, fatty liver disease, and other serious health conditions. As the science advances,... Read More »
The rapid pace of medical innovation has transformed the treatment of many serious diseases. New weight-loss medications, targeted cancer therapies, biologic drugs for autoimmune disorders, and other specialty medications are helping patients live longer, healthier lives. Unfortunately, these treatments are often among the most expensive prescription drugs on the market, making them frequent targets... Read More »
The California Department of Managed Health Care (DMHC) exists to protect consumers by regulating health care service plans and enforcing some of the nation’s strongest health insurance laws. The agency oversees most HMOs and many PPOs in California, as well as the majority of Medi-Cal managed care plans. In total, approximately 236 health plans,... Read More »
Bringing a new child into the world should be a time of celebration, not a battle with a health insurance company over whether a newborn’s medical care will be covered. Yet that is exactly what happened in two cases that recently resulted in enforcement action by the California Department of Managed Health Care (DMHC).... Read More »
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