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Doctor, hospital groups organize to oppose single-payer in California

A group of influential, deep-pocketed business and health care organizations that have long helped shape the legislative agenda in California have joined forces to oppose any future effort to craft a universal, single-payer health care system for the nation’s largest state. The main focus of the coalition, called “Californians against the costly disruption of our health care,” is to kill any single-payer health care bill in the state Legislature, said Ned Wigglesworth, a political strategist for the coalition. Read More...

Health Net Federal Services experiences significant challenges with TRICARE transition

On January 1, 2018, Health Net Federal Services (HNFS) became the new Defense Heath Agency (DHA) managed care contractor for the TRICARE West Region, serving approximately 2.9 million beneficiaries in 21 western states, including California. HNFS took over the contract previously held by UnitedHealthcare Military and Veterans’ Services (UMVS). The California Medical Association (CMA) has learned that HNFS has experienced implementation issues related to provider contracting and credentialing, beneficiary reassignment to new primary care managers (PCM), and provider directory inaccuracies. Read More

Health Net to rescind recently announced payment policies

Since Health Net first notified physicians in March of planned changes to its modifier 25 and emergency services payment policies for Medicare and Medi-Cal lines of business, the California Medical Association (CMA) has been working to educate the payor about physician concerns with the new policies. Last month Health Net agreed to delay implementation of the new policies until July 1, 2018, to allow time to review provider concerns with the new policies and to continue discussions with CMA and other stakeholders. “We believe a more collaborative approach to identify alternative ...

CMA survey finds rampant health plan payment abuses

Despite a California law passed in 2000 to address widespread payment abuses by health care service plans, many payors continue to flout the law. A recent survey by the California Medical Association (CMA) confirms that health plans regularly engage in unfair payment practices, with two-thirds of physician practices reporting routine payment abuses in violation of state law. The Department of Managed Health Care (DMHC) has been slow to address provider complaints and has taken few enforcement actions against health plans that unlawfully underpay providers. When DMHC has acted, the penalty ...

Raise taxes or ration health care? Why single-payer won't work in California. Yet

Betty Doumas-Toto's health insurance premium rose nearly 48 percent in January, to $800 per month for an Affordable Care Act plan. She and her husband are both Los Angeles freelancers in the film industry and are draining their savings trying to keep up with their monthly payments. A Pomona mother of five named Claudia, who is undocumented, can't get health insurance because of her immigration status. She's losing her hearing, but can't afford tests a doctor ordered because the costs are too high. At an elder care home in the Sacramento ...