- The California Department of Managed Health Care is the country's first government agency dedicated to regulating health plans and assisting consumers to resolve disputes with them.
The DMHC oversees full-service health plans, including all California HMOs and some PPOs, as well as specialized plans such as dental and vision.
Overall, the DMHC regulates approximately 90 percent of the commercial health care marketplace in California.
Created by consumer-sponsored legislation in 1999, the Department of Managed Health Care is funded by health plan assessments, with no taxpayer contributions.
DMHC's main priorities are to protect enrolees rights,
Educate consumers about their rights and responsibilities
Ensure the financial stability of the managed health care system
And to assist Californians in navigating the changing health care landscape.
To protect Californians, the Department of Managed Health Care offers several services, including a Consumer Help Center.
The Consumer Help Center is a free resource and can help Californians resolve issues with their health plans -- such as:
◦Denials of care and treatment
◦Denials of prescriptions drugs and therapies
◦Delays in getting referrals, authorizations and diagnostic tests
◦Problems coordinating timely medical care
◦Claims, billing and co-pay issues
◦Keeping existing providers when health plan network contracts change
◦Cancellations of coverage
◦ Access to translation and interpretation services
· Health plans are required to apply for and maintain a license to operate as a health plan in California.
The Department of Managed Health Care reviews all aspects of the plan's operations to ensure compliance with California law.
This includes, but is not limited to,
Evidences of Coverage, contracts with doctors and hospitals, provider networks, and complaint and grievance systems.
The DMHC reviews proposed premium rate increases to make sure health plans are providing detailed information to the public - to justify the proposed increases .
While the DMHC does not have the authority to deny rate increases, it's oversight improves accountability in the setting of health plan rates.
The DMHC has saved policyholders millions through its premium rate review program.
The Department of Managed Health Care actively monitors the financial stability of health plans and medical groups to ensure that plans, and those entities they contract with, can meet their financial obligations to consumers.
The Department of Managed Health Care works to aggressively monitor and take timely action against plans that violate the law.
During this time of great change in California's health care delivery system and confusion among California's health care consumers, the California Department of Managed Health Care is here to assist Californians as they navigate the changing health care system.
For more information visit http://www.dmhc.ca.gov