Insurance Issues In California

On November 18th the California Department of Managed Health Care (DMHC) sent “cease and desist” orders to three  insurers that denied coverage for speech and occupational therapy services without determining whether such care was medically necessary, the Sacramento Business Journal reports.

The three companies that received these orders were:

  • Anthem Blue Cross, which received 14 complaints;
  • Blue Shield of California, which received 24 complaints; and
  • Health Net, which received 41 complaints.

According to the DMHC, all three of these companies’ policies on speech therapy coverage violated state law.

In response, all three companies said they would be ‘reviewing their orders and considering how to move forward’. But according to DMHC spokesperson Marta Green, the companies can choose to appeal the orders and risk having their cases rejected by the state (which would mean the insurance companies would have to reimburse policyholders the cost of speech therapy).