On June 18, 2022, CSAP Legislative Advocate Paul Yoder of SYASL and several members of the SCPS Access to Care Committee (Committee Chair Gillian Friedman, MD, Torie Sepah, MD, and Rob Burchuk, MD) met with Amanda Levy and Nathan Nau, deputy directors from California’s Department of Managed Health Care (DMHC).
Paul Yoder facilitated the meeting to discuss specific examples Dr. Sepah brought forth of irregularities and substantial barriers in insurance coverage with a few insurance carriers. Ms. Levy and Mr. Nau offered the following resources that are already available from DMHC: 1) DMHC’s Help Center, which can assist in filing for an Independent Medical Review (IMR) if the insurance plan’s appeal process has not brought resolution in 30 days (or earlier if care is emergent): 1-888-466-2219, or follow the link “Independent Medical Review/Complaint Form” on the www.dmhc.ca.gov website; (2) the provider complaint line where practitioners can report sustained patterns of unfair payment: 1-877-525-1295. Ms. Levy and Mr. Nau noted that the DMHC is in its second year of a five-year review of 25 major insurance networks under the DMHC’s jurisdiction in California. These reviews are not only evaluating for any violations of California law, but are also collecting information from patients and practitioners about real-world barriers that remain in receiving and providing needed services with these insurance companies, with the ultimate goal to report these barriers back to the California legislature.
DMHC staff committed to a future webinar for CSAP members about DMHC resources and activities; stay tuned for updates.