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Practice Tip: Report Health Plan Abuses
In recent years, CMA-sponsored laws have given state agencies the power to take action against insurers that repeatedly engage in unfair payment practices. It is important, however, that physicians be able to identify these unfair payment practices. Without physician complaints, the regulations will be useless, and abusive health plan behavior will not change. For help identifying unlawful payment practices, see CMA’s payor abuse action guide, “Payor Abuse Matters.” This guide is available free to members at the members-only website. Nonmembers can purchase the guide for $100 in the CMA Bookstore, CMA Bookstore. Please be aware that when the guide was published, the protections applied only in regard to health plans regulated by the Department of Managed Health Care (DMHC). Since then, a law has been passed granting similar protections to physicians contracted with insurers regulated by the Department of Insurance (DOI). If you have been subject to unfair payment practices, see CMA ON-CALL document #1051, “Complaints about Managed Care Plans,” for more information on filing complaints with DMHC or DOI. ON-CALL documents are free to members at the members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA Bookstore. Click here for more information. Contact: CMA's reimbursement help line, 888/401-5911.
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