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California Department Of Managed Health Care

April 5, 2012 | By Lisa Zamosky, Special to the Los Angeles Times
Our 7-year-old daughter awoke screaming and could not be comforted or touched. We took her to the emergency room. Now our insurance company is denying the visit, saying that it wasn't medically necessary for her to be seen in the ER. Yet the emergency room physician considered a spinal tap to rule out meningitis. How could this visit not be necessary? The situation you describe certainly seems to qualify as an emergency, and you should fight to have your insurer pay for your daughter's ER visit.
March 8, 2005 | Lisa Girion
Blue Cross of California and Pomona Valley Hospital Medical Center reached a multiyear service agreement, resolving disagreements that had led Blue Cross to drop Pomona Valley from its provider list last month. The California Department of Managed Health Care had ordered Blue Cross to cover its members' visits to the hospital until it had prepared adequate alternative care plans. The new contract between Blue Cross, a unit of health insurer WellPoint Inc.
January 11, 2002 | From Staff and Wire Reports
The California Department of Managed Health Care dropped several allegations against Kaiser Permanente during a hearing into the validity of a $1.1-million fine against the state's largest HMO. The state dropped its claim that Kaiser lacks adequate ambulance services at its Hayward emergency room. Regulators also deleted claims relating to Kaiser's telephone call center, through which patients make appointments or ask medical questions.
November 14, 2000
Safeguard Health Enterprises Inc.'s pending recapitalization and change of control cleared another regulatory hurdle, the Aliso Viejo company said Monday. The California Department of Managed Health Care has approved the move just days after the state Department of Insurance gave it the green light. Safeguard had agreed in March to an $8-million cash infusion from an investor group, which will convert the debt into shares. The company said the transaction is essential to its financial health.
August 2, 2013 | By Lisa Zamosky
Americans love to look good, but insurers are often reluctant to pay the bills to help us look better. Last year we spent nearly $11 billion on cosmetic procedures, according to the American Society for Aesthetic Plastic Surgery. Of the more than 10 million procedures performed, the most requested was breast augmentation. But Cameo Wichinsky, a 42-year-old investment fund manager living in Santa Monica, wants to take her figure in the opposite direction. Having long lived with the discomfort of breasts large enough to cause shoulder and neck pain and to limit her level of physical activity, she's ready to go under the knife to reduce her breast size and, she hopes, improve her quality of life.
June 28, 2002 | From Times Staff and Wire Reports
An appeals court ruled Thursday that state HMO regulators cannot force Kaiser Permanente to pay for the anti-impotence drug Viagra, upholding a lower court ruling. The California Department of Managed Health Care had argued that the law required health plans to cover all medically necessary prescription drugs for members if the HMO chose to offer any drug coverage at all.
September 29, 2009 | Patrick McGreevy
A former deputy director for the California Department of Managed Health Care has agreed to pay a $3,000 administrative fine after admitting a conflict of interest violation, the state's ethics watchdog agency said Monday. Kevin Donohue, who still works for the agency in another capacity, admitted he held stock in UnitedHealth Group Inc. when he helped review the 2005 merger of the firm with PacifiCare Health Systems Inc., according to a stipulated settlement with the state Fair Political Practices Commission.
January 7, 2014 | By Chad Terhune
Blue Shield of California said it has agreed to acquire GemCare Health Plan, expanding its presence in Kern County and the Central Coast area. Blue Shield, one of the state's largest health insurers, said Tuesday that GemCare customers should see minimal changes at first. Terms of the deal weren't disclosed. GemCare, based in Bakersfield, is owned by hospital chain Dignity Health and the physicians of GemCare IPA. Blue Shield said the deal would enable it to grow its overall membership and provider networks as well as add Medicare patients in Kern, San Luis Obispo and Santa Barbara counties for the first time.
May 10, 2013 | By Chad Terhune, Los Angeles Times
A worrisome abdominal pain drove Jalal Afshar to seek treatment last year at healthcare giant Kaiser Permanente. The Pasadena resident and Kaiser member had lived for years with a rare condition known as Castleman's disease, which affects the lymph nodes and the body's immune system. But this was the first time he experienced such severe symptoms. Kaiser granted his request to see a specialist in Arkansas. But it ultimately declined to pay for his treatment there. By June, Afshar said, Kaiser was arranging for hospice care so that he could die at home.
October 11, 2009 | Times Staff and Wire Reports
Several large health maintenance organizations and insurers in California have agreed to refrain from charging co-payments or deductibles for vaccinating patients against the H1N1 flu. State regulators said they obtained agreements from the companies to waive all charges for administering the vaccine, which is provided free by the federal government. "The likelihood that some health insurers would charge some administrative fee for the vaccine was very, very high," state Insurance Commissioner Steve Poizner said in a conference call.
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