Covered California and Medi-Cal share a computer system for eligibility and enrollment. Nearly a decade since the Affordable Care Act expanded coverage options in the state, enrollees can be diverted to the wrong program — or dropped altogether — if erroneous information gets into the system.
Preventive care, like screening colonoscopies, is supposed to be free of charge to patients under the Affordable Care Act. But some hospitals haven’t gotten the memo.
Insurers say prior authorization requirements are intended to reduce wasteful and inappropriate health care spending. But they can baffle patients waiting for approval. And doctors say that insurers have yet to follow through on commitments to improve the process.
Even the savviest Medicare drug plan shoppers can get a shock when they fill prescriptions: That great deal on medications is no bargain after prices go up.
The Fierro family owed a Yuma, Arizona, hospital more than $7,000 for care given to mom and dad, so when a son dislocated his shoulder, they headed to Mexicali. The care was quick, good, and affordable.
A controversial proposal to grant HMO giant Kaiser Permanente a no-bid statewide Medicaid contract is headed for its first legislative hearing amid vocal opposition from a coalition of counties, competing health plans, community clinics, and a national health care labor union.
Diagnosed with aggressive leukemia on a Western trip, a young man thought his insurance would cover an air ambulance ride home to North Carolina. Instead, questions about medical necessity left him with an astronomical bill.
The insurance company said that the birth of the Bull family’s twins was not an emergency and that NICU care was “not medically necessary.” The family’s experience with a huge bill sent to collections happened in 2020, but it exposes a hole in the new No Surprises law that took effect Jan. 1.
In May 2021, Lags Medical Centers, one of California’s largest chains of pain clinics, abruptly closed its doors amid a cloaked state investigation. Nine months later, patients are still in the dark about what happened with their care and to their bodies.
The backroom deal with politically connected Kaiser Permanente, which infuriated other Medi-Cal health plans, allows the health care giant to continue selecting the enrollees it wants.
