CMA and AMA urge DOI to oppose Anthem and Cigna merger Last week, the California Medical Association (CMA) testified before the California Department of Insurance (DOI), urging it to oppose the proposed merger of Anthem and Cigna. “We are concerned with the impact of this merger on physicians and patients,” said Francisco Silva, CMA general counsel and senior vice president. “We are concerned that this merger would compromise access to health care, health care quality and patient affordability.” The American Medical Association (AMA) also sent representatives to the hearing to testify against the merger. “We oppose Anthem’s goal of dominating the California ... April 4, 2016 General Department of Insurance, Anthem Blue Cross, Cigna, Regulatory advocacy 0 0 Comment Read More »
Final regulations requiring health insurers to have adequate networks and accurate directories go into effect The California Department of Insurance (CDI), which regulates most PPOs in the state, issued permanent regulations this week that require health insurers to develop and maintain adequate provider networks. This move comes after emergency regulations were issued in January 2015 to help ensure patients can get timely access to care. While the California Department of Managed Health Care (DMHC), which regulates HMOs and certain PPO products, has had in place network adequacy standards for a number of years, CDI has not. These regulations will thus ensure that Californians, regardless of ... March 31, 2016 Managed Care Medical Provider Networks, Network Adequacy, Provider Networks, Department of Insurance 0 0 Comment Read More »
New approval timeframes for prescription drug prior authorizations took effect Jan. 1 A new law took effect Jan. 1, 2016, that requires health plans and health insurers to respond to prescription drug prior authorization requests within 72 hours for non-urgent requests and 24 for urgent requests. The law (SB 282) deems such requests to be granted if the payor fails to respond within these timeframes. A previous law (SB 866) had required a determination within two business days or the request was deemed approved. SB 282 also requires the Department of Managed Health Care and the Department of Insurance to create a ... January 15, 2016 General Department of Managed Health Care, Preauthorization, Prescription Drugs, Department of Insurance 0 0 Comment Read More »
Regulations requiring health insurers to have adequate networks and accurate directories go into effect Emergency regulations requiring health insurers regulated by the Department of Insurance to create and maintain adequate medical provider networks to provide timely access to medical care went into effect this week, after their approval by the Office of Administrative Law. California Insurance Commissioner Dave Jones issued the emergency regulations in early January. "Californians and California businesses deserve better than what they have gotten from most health insurers and HMOs,” Jones said. "This emergency regulation is necessary to make sure that health insurers establish and maintain adequate medical provider networks to meet ... February 5, 2015 General Medical Provider Networks, Network Adequacy, Out of Network Care, Department of Insurance 0 0 Comment Read More »
