California's state regulatory agency, the Department of Managed Health Care, oversees all HMOs in the state as well as some PPOs, Medi-Cal Managed Care Plans and Medicare Advantage Plans.
The Department of Managed Health Care (DMHC) is charged with enforcing violations by the plans, in accordance with the Knox-Knee Act, and acts as a consumer protection agency for patients' rights.
With Anthem Blue Cross, a subsidiary of WellPoint, in the news with their impending rate hikes in California, a story from Reuters confirmed some of Anthem's egregious behaviors as investigated by the DMHC. It was found that Anthem had canceled the policies of people who had been diagnosed with costly illnesses, all illegally:
The DMHC randomly selected 90 instances in which Anthem Blue Cross of California, one of WellPoint's largest subsidiaries, canceled the insurance of policy holders after diagnoses with costly or life-threatening illnesses to determine how many were legally justified.
"In all 90 files, there was no evidence (that Blue Cross), before rescinding coverage, investigated or established that the applicant's omission/misrepresentation was willful," the DMHC report said.
The result: The agency concluded that Anthem Blue Cross lacked legal grounds for canceling policies in every single instance.
The DMHC website has a search tool to find enforcement actions taken, categorized alphabetically by organization name, where a plan member can see if their provider has been inolved with any violations and what, if any, action was taken to correct them. Violations can include, canceling a policy, operating a health care service plan without a license or failure to provide in-patient hospital services. The link to the search tool is here.
Anthem Blue Cross has the most enforcement actions listed, 457, with Blue Cross of California and California Physcian's Service in second, with 102 actions each. Ms. Angela Braly, CEO of WellPoint testified before Congress a few weeks ago where she stated the rate hikes are necessary since the business of insurance is risky and expensive.
The DMHC can also answers questions about your plan, offers a health care quality report card and independent medical reviews of your plan. They can be reached at 1-888-466-2219.
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