California Department of Managed Health Care

So how do we do that?

This is putting pressure on your local representative, and then in a similar way in, in your state, there is going to be a Department of Managed Care at a state level.

And so at the state level, reporting to Department of Managed Care when you feel like your access is not adequate or on par with your medical access.

So I can call my insurance plan, ask for a primary care provider, get a name, call that provider, and get an appointment within a few days.

Terrific.

So that's unacceptable.

So first, do be a squeaky wheel with your insurance plan, and so you need to be demanding better access.

And then that would be something that you could also take to Department of Managed Care and let them know what's happening and put a report in.

So first, the Department of Health Care Services, or DHCS, they established the rules for California's Medi-Cal fee-for-service system.

The Department of Managed Health Care, or DMHC, regulates most California health plans, HMOs, and then certain Medi-Cal managed care plans as well.

The California Department of Insurance, or CDI, regulates traditional PPO insurance plans and combined life and health insurance plans.

And again, as we get into Senate Bill 306, we'll see how the bill incorporates oversight entities into the overall remodel in California.

I don't think that necessarily happens a whole lot, but I think that's the goal behind it.

And then lastly, external review.

External review of the prior authorization denial is often permitted by either DMHC or CDI.

And moving on, this is just a minor point to be aware of.

And this office has a huge investigation and study harm and should absolutely be using this office as a bully pulpit to make health care more fair.

So how would that work, though? You don't see the insurance department necessarily taking over what the Department of Managed Health Care does around the regulation, but this would be sort of a policy area that you would push forward?

Yeah.

Unfortunately, via Prop 103, this office doesn't regulate managed health care plans.