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Health Maintenance Organizations

June 1, 1989
Maxicare Will Cut 100 Jobs: Maxicare Health Plans Inc. said it will eliminate about 100 jobs at its corporate headquarters in Los Angeles. The company, which in March filed for protection from creditors under Chapter 11 of the federal bankruptcy code, said it is reducing staff, effective July 28, because it operates substantially fewer health maintenance organizations. Maxicare has sold more than 20 operations since early 1988.
May 19, 2008 | Joseph Michelson, Special to The Times
The nonmobile, hard lump had been on my sternum (the bone in the center of the chest) for many months. As a physician, I had figured it was costochondritis -- an inflammation -- from years ago that had hardened with age. A CT scan, however, stated otherwise: "Consistent with metastatic carcinoma or lymphoma. . . . " That meant the lump was likely due either to a cancer that had spread throughout my body or to a cancer of the lymphatic system, which manifests in different locations.
Secure Horizons, the nation's largest Medicare HMO, said Thursday it will freeze membership next year in 41 counties nationwide, most of them in California. The announcement that new members will not be accepted in 24 California counties, among them Riverside, San Bernardino, Santa Barbara, Kern, Alameda and Contra Costa, came as Secure Horizons' parent company reported disappointing results for the third quarter, though they beat estimates. Santa Ana-based PacifiCare Health Systems Inc.
April 1, 2008 | Jordan Rau, Times Staff Writer
Gov. Arnold Schwarzenegger's administration has moved to ban physicians and hospitals from billing patients for the cost of services above what their HMOs are willing to pay. Such bills, which patient advocates call a consumer abuse, are the product of a protracted feud between insurers and healthcare providers, principally emergency room doctors, radiologists and anesthesiologists.
March 26, 1989 | BRANT S. MITTLER, M.D., BRANT S. MITTLER, a cardiologist in San Antonio, is president of Physicians Who Care, a national grass-roots organization with a broad agenda of public education issues, including the promotion of private practice in medicine. He is also a medical reporter for KENS-TV in San Antonio. and
The financial troubles of Maxicare, at one time the largest for-profit health maintenance organization in the United States, do not mark the beginning of the end of the troubled HMO industry. Rather, Maxicare's troubles merely clear the decks for the emergence of a strengthened movement in government and industry to force medical consumers into HMOs.
PacifiCare Health Systems and Health Plan of America on Tuesday announced a proposed merger that would form one of the three largest health maintenance organization in California, company officials said. The merger would give Cypress-based PacifiCare the foothold in Northern California that its rivals, including FHP International Corp. in Fountain Valley, have sought.
Contrary to many expectations, older heart attack patients enrolled in health maintenance organizations received better medical care than similar patients treated by private doctors, according to a new study from the UCLA Medical Center and the Santa Monica-based RAND Corp. The results, announced Saturday in Seattle at a meeting of the American Federation for Clinical Research, reinforce studies over the past decade.
The short, bearded man in a gray, double-breasted suit walked swiftly through a Long Beach medical clinic, pivoting often to point out cosmetic flaws that might mar the image of the health-care organization he spent a lifetime building. The clinic's young managers obediently took notes as Dr. Robert Gumbiner pointed scornfully to some tattered telephone directories, wheelchairs that obstructed a hallway and two pictures hung askew in a waiting room.
December 24, 1992 | DON LEE, TIMES STAFF WRITER
In what analysts say could be the nation's largest initial public offering of a health insurance firm, Blue Cross of California next month hopes to raise more than $400 million in a stock sale from its new for-profit subsidiary. Blue Cross, based in Woodland Hills, is currently a nonprofit entity. But its new subsidiary, WellPoint Health Networks Inc., will represent virtually all of Blue Cross' operations, having 2.1 million members statewide.
February 5, 2008 | Jordan Rau, Times Staff Writer
In 2002, California's HMO czar, Daniel Zingale, declared, "The days are over when they could make patients wait and wait for healthcare." Zingale was heralding a new law that required his department to ensure that HMO patients received timely appointments with doctors. The law was spawned by the case of a 74-year-old woman who died from an aneurysm in a Kaiser Permanente waiting room while pleading to see her physician.
October 19, 2007 | Lisa Girion, Times Staff Writer
Many Californians enrolled in healthcare plans are receiving inadequate preventive care, a government report said Thursday. The eight largest plans in the state fail to ensure that their 12 million members are sufficiently tested and treated to prevent and detect major diseases and reduce unnecessary expenses, according to the California Office of the Patient Advocate's report, called the Health Care Quality Report Card.
September 22, 2007 | Charles Ornstein, Times Staff Writer
A highly unusual battle erupted in a San Diego courtroom Friday, with parents of a severely premature baby seeking to force healthcare giant Kaiser Permanente to move their son to a better-equipped hospital in hopes of saving his life. In the morning, Superior Court Judge Kevin Enright gave Kaiser's San Diego hospital 24 hours to transfer 7-week-old Andrew Balaka-Long to a higher-level neonatal intensive care unit outside the Kaiser network.
August 29, 2007 | Lisa Girion, Times Staff Writer
Eight months after pledging to put the brakes on retroactive cancellations of individual health insurance policies, the state agency that regulates HMOs said Tuesday that new rules were taking longer than anticipated because of the variety of health plans involved. Cindy Ehnes, director of the California Department of Managed Health Care, pledged in December to introduce regulations aimed at stopping most retroactive cancellations of individual coverage. The department held a public hearing Jan.
July 26, 2007 | Tracy Weber and Charles Ornstein, Times Staff Writers
Kaiser Permanente will be assessed a record fine today for its haphazard investigations of questionable care, physician performance and patient complaints at its California hospitals, according to state HMO regulators. The California Department of Managed Health Care said it will levy a $3-million fine against Kaiser, the largest HMO in the state, with 29 medical centers and more than 6 million members.
July 17, 2007 | Lisa Girion, Times Staff Writer
State regulators Monday postponed a hearing originally set for this week on complaints against Blue Cross of California, because its parent company has requested a more detailed agenda. The hearing now is set for Aug. 7 in Los Angeles. The state Department of Managed Health Care, which oversees HMOs, said last week that it had received more than 1,600 complaints from policyholders and doctors in less than three years against Blue Cross, the state's largest health insurer.
January 30, 2007 | Lisa Girion, Times Staff Writer
The state's top HMO regulator said Monday that health plans should be required to get outside review before dropping a policyholder, a dramatic step up in oversight that probably would face stiff challenges from the industry. Cindy Ehnes, director of the Department of Managed Health Care, said she hadn't yet developed details on how such a requirement would work.
January 3, 2007 | Lisa Girion, Times Staff Writer
Kaiser Foundation Health Plan Inc. said Tuesday that it was working with state regulators to develop standards to protect its members from unfair cancellations of health insurance, a move that the state's largest HMO hopes could lead to industrywide reforms. Kaiser's move comes as it was being fined $100,000 by state regulators for dropping a policyholder it accused of concealing his epilepsy when he applied for coverage, even though the condition had never been diagnosed by a physician.
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