Raul Ramirez, Director
News and Public Affairs
KQED Public Radio

Dear Mr. Ramirez:

I appreciate this opportunity to address the concerns raised by one of my constituents during KQED Public Radio's The California Report on "Health Care Rationing" on November 13th. I am always pleased to hear from individuals I represent in the Assembly who voice their concerns and participate in dialogues about public policy.

Julie from Sacramento called the show and described how she suffers from a chronic illness that has not responded to any conventional medical therapies. In working with her physician, she found a complementary/alternative treatment that seems to help her, but her insurance does not cover this treatment.

Many alternative treatments, such as acupuncture and chiropractic care, are becoming mainstream. More and more doctors are suggesting these treatments as effective responses to patients' illnesses.

I encourage anyone who has treatment that is recommended by their health care provider but which is denied by their HMO or health insurer to appeal the decision. California has some of the strongest patient-protection laws of any state, including a requirement that HMOs have an internal grievance system for their enrollees to appeal denials of care. If the grievance a patient files is unsuccessful, an enrollee can appeal to have his or her case decided by Independent Medical Review (IMR). IMR is a way for doctors and other health care professionals outside the patient's HMO to make independent decisions about patient health care.

Additionally, complaints about coverage limitation can be submitted to the Department of Managed Health Care's complaint resolution process. Information about the state's patient-protection laws is available on the Department's web site at www.dmhc.ca.gov.

During the last legislative session, more than a dozen bills were proposed to require HMOs to cover additional services, including one bill that proposed to require HMOs to cover acupuncture. Bills such as these are referred to as "benefit mandates," and typically require HMOs and health insurers to provide certain benefits as part of every product they sell. Benefit mandates are typically passed to expand the scope of services covered by health insurance. However, legislative action on the proposed benefit mandates was deferred last session because health care costs are increasing at double-digit rates, and many California employers and individuals are having difficulty paying for health coverage now. Instead, the Legislature requested that the University of California review and assess the medical, public health and economic impacts of any proposed benefit-mandate legislation.

Some businesses offer discount cards for individuals to purchase health care services. However, anyone who is considering buying such a card should verify that the health care provider participates in the discount program and offers a discount off the fees currently paid out-of-pocket.

Thank you again for allowing me to respond.

Sincerely,

Darrell Steinberg
9th Assembly District