The California Department of Managed Health Care, launched in July 2000, has announced a new program, Independent Medical Review. The program allows patients who have been denied treatment or medical care to have those decisions reviewed by physicians or other appropriate medical professionals who have no affiliation with their health plans.
The Independent Medical Review program provides patients with an impartial review of health plan denials, delays, or modifications of services based upon
the finding that they are not medically necessary; health plan denials of experimental or investigational treatment (for patients with life-threatening or seriously debilitating conditions); and health plan denials of reimbursement for emergency or urgent medical services.
The Department has developed an online database of Independent Medical Review decisions (excluding patient, provider or facility information). Searches can be conducted by diagnosis or treatment category at www.hmohelp.ca.gov.
For more information about the Department of Managed Health Care, the HMO Help Center or the Independent Medical Review Program, go to www.hmohelp.ca.gov or call (888) HMO-2219.
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