Yamileth Medina

Health Insurance in California Becomes Quicker



Posted: Thursday, January 21, 2010

by
VitalOne Health

The surprise election of Massachusetts Republican (and healthcare reform opponent) Scott Brown to the Senate is not the only important health insurance-related news this week. State regulators have made some changes to the way health insurance in California is provided. The rules were actually enacted in 2002, but are only taking effect now. These regulations will have both positive and negative impacts on HMO patients in the state. Although the rules allow for some flexibility on doctors' behalf, certain groups fear that it is not the right time to take such action, and that the new time standards will do more harm than good. If successful, these reforms could spread nationwide.

In total, three-fifths of the state's residents have HMO plans. This includes millions of individual health insurance California patients. One of the primary complaints about HMO health insurance is that it simply takes too long to get a doctor's appointment. The new laws serve as consumer protection for 21 million Californians; they are the first time standards in the nation. However, many health insurance industry experts believe that the current shortage of primary care physicians will make it costly and nearly impossible to enact.

Under the rules, doctors that work with HMO health insurance in California must be available to answer health-related phone calls 24 hours a day from their patients. When a patient calls regarding treatment or an appointment, physicians must respond within 30 minutes. When it comes to medical appointments, requirements are also strengthened: any HMO patient should be able to visit a general care physician no more than 10 days after making an appointment. After making an appointment with a specialist, that specialist must see him or her within two weeks.

Currently, the managed care health insurance plans in major cities fall short. HMO patients living in Los Angeles have to wait 59 days on average--nearly two months--to get a basic physical. In San Diego, the average wait is 24 days. Advocates for the time standards claim that such delays can make the difference between an easy, affordable treatment for a minor condition and costly, grueling medical care. Skeptics believe that the potential cost savings is too vaguely defined and would not be enough to outweigh the increase in the number of doctors HMO health plans must hire to fulfill the requirements. Health insurance premiums will likely rise as a result.

Regulations targeted at health insurance in California are in a difficult political position. How is the state, currently in a crushing budget crisis, planning to enforce these rules? According to the Department of Managed Care, which is in charge of writing and enforcing regulations for the industry, it will respond to consumer complaints of extremely long wait times for health care access by ordering an audit of the HMO plan's records. If the insurer is found to be in violation, they will be charged a fine. The amount of the fine has not been specified.

(Image: tkksummers under CC 2.0)

Yamileth Medina is an up and coming expert on Health Insurance and Healthcare Reform. She aims to help people realize that they can find quality individual health insurance right now. Yamileth lives in Miami, FL.
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