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California Department Of Managed Health Care

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.
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.
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.
April 5, 2013 | By Lisa Zamosky
When Keith Yaskin and his wife, Loren, rushed their 2-year-old son to the hospital with a dangerous infection in his neck, they weren't thinking about how much his care would cost. After his three-day inpatient stay with nonstop intravenous antibiotics, they were hit with $8,900 in charges. But the toughest lesson for the Scottsdale, Ariz., couple came a month or so later when they began to sort out the hospital bills. Their insurance policy had a $10,000 deductible. So they scrutinized every item, made some calls and had a few surprises.
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.
June 25, 2013 | By Chad Terhune
California officials have fined healthcare giant Kaiser Permanente $4 million for problems related to patient access to mental health services. The fine announced Tuesday stems from deficiencies the California Department of Managed Health Care identified in March that were found during a routine medical survey. This marks the agency's second-largest enforcement action after a $10 million fine against Anthem Blue Cross in 2008 related to improper policyholder cancellations. "The Department's actions are a result of both the seriousness of the deficiencies and the failure of Kaiser to promptly correct them," said Brent Barnhart, director of the Department of Managed Health Care.
January 19, 2010
New rules The California Department of Managed Health Care has issued regulations for HMOs requiring timely access to medical care. Plans have one year to comply. Consumers can complain to the department at (888) 466-2219 or Among the rules for HMOs: Patients with urgent matters that require "prompt attention" must be seen by a physician or other healthcare professional within 48 hours of requesting an appointment. Urgent care with specialists must be provided within 96 hours.
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