ANCO is aware that members are increasingly faced with preauthorization/certification, claims processing, appeals, and payment hurdles by their third-party payers.
There are two resources available to ANCO members that may be able to assist you with these hurdles.
First, the Department of Managed Health Care (DMHC) has patient and physician resources to help resolve disputes with health care service plans. A memo from the DMHC to ANCO members describing these resources and how to take advantage of them.
Second, ANCO members that are also members of the California Medical Association (CMA) may utilize the services of CMA's Center for Economic Services (CES) by calling their Reimbursement Helpline at (888) 401-5911. If you are not currently a CMA member, then you should really consider joining your county medical society and CMA to take advantage of the CES's services.
Both DMHC and CMA can help you resolve your disputes with third-party payers. And, more importantly, by using these services, you will be helping DMHC and CMA hold third-party payers accountable for their actions with respect to current law/regulation and contribute to the formulation of future law/regulation.