Posted on 06/22/2015 3:24:15 PM PDT by Oldeconomybuyer
In an effort to control costs in its rapidly expanding Medi-Cal program, California has relied heavily on managed care insurance companies to treat patients. The state pays insurers a fixed amount per enrollee and expects the companies to provide access to doctors and comprehensive care. But a scathing state audit released last Tuesday shows that California is failing to make sure those plans deliver. Many enrollees have insurance cards but often have trouble getting in to see doctors.
The California audit found the state didn’t verify that insurers’ directories of doctors were accurate or that the plans had enough doctors to meet patients’ needs. The state Department of Health Care Services also didn’t do its own required annual audits of the plans.
The audit focused on three health plans but underscores a broader problem in California: the lack of sufficient oversight of a program that now serves about 12 million beneficiaries, three-quarters of whom are in managed care.
New proposed federal regulations designed to improve Medicaid managed care could help by requiring states to ensure patients have enough access to doctors and hospitals, limiting profit margins and establishing a quality rating system for plans.
(Excerpt) Read more at khn.org ...
umm sounds to me like Kaiser is trying to horn in on the Medi-cal managed care business... I am sure LaCare, Caloptima and Inland Empire Health Care are all shaking in their boots... it’s the reimbustment rate that keeps dr’s from seeming medi-cal patients
Kaiser takes great care of my 84 year old Mom, but when I had them all they cared about was pro active medicine. Had the Ortho I went o with them been a tad more concerned with really finding out what was wrong I might have at least put off the two major surgeries I had in the last seven months. But The Ortho was content to misread xrays,not order an MRI and tell me to just cope with the pain because it would maybe just go away in a few weeks, I'm sure the fact that my policy was running out in a month had nothing to do with it.
“The California audit found the state didn’t verify that insurers’ directories of doctors were accurate or that the plans had enough doctors to meet patients’ needs. The state Department of Health Care Services also didn’t do its own required annual audits of the plans”
Incompetence masquerading as underfunding. The great socialist failure ,aka, California will squeeze more money out of taxpayers one way or another because “it’s for the children”
Nothing will change, rinse and repeat.
-——New proposed federal regulations ——
yes but you see, there will be new regulation tweaking the previous regulation tweak that will make it all better.
there are so many fed regulations on health insuance, insurance companys are always being audited by either the state or feds
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