The California Department of Managed Health Care (DMHC) ordered Health Net, Anthem Blue Cross, and Blue Shield of California to cease and desist from denying their members access to medically necessary speech therapy and/or occupational therapy. DMHC said the plans denied coverage without determining whether the services were medically necessary. DMHC issued a $300,000 fine against Health Net for repeatedly mischaracterizing requests for services as coverage issues rather than medical necessity issues.
DMHC Director Brent Barnhart said, “Today’s actions will ensure that members get the care required by law. Additionally, the plans will be required to identify and reimburse members who paid out-of-pocket for medically necessary therapy after those services were inappropriately denied.”
