Physicians and their practices are frequently plagued by payment issues with insurers and the government. Underpayment or lack of payment jeopardizes the economic viability of physicians and their practices, and in so doing, threatens patients' access to care.
The California Medical Association (CMA) has worked to ensure physician economic stability in several critical ways:
- Preventing onerous provisions from getting into physician contracts;
- Providing physicians the tools to assess whether to sign contracts in the first place; and
- Helping physicians overcome barriers to receiving prompt and fair reimbursement.
CMA has also long advocated for comprehensive health insurance market reform, to rein in profit-driven health plans that inappropriately delay or deny care, including:
- Advocating for fair and timely payment of provider claims by alerting legislative and regulatory bodies about HMO payment abuses.
- Ensuring that a reasonable portion of every health care premium dollar goes to direct patient care, and not to health plan profits or wasteful administrative expenses. Congress included a minimum medical loss ratio (MLR) requirement in federal health care reform at CMA's urging.
- Battling for years to prohibit health plans from unfairly rescinding health coverage after costly claims arise, leaving sick patients with no insurance and nowhere to turn for desperately needed care. This provision was eventually included in the landmark federal health care reform law.
- Preventing draconian cuts in the already unconscionably low Medi-Cal provider reimbursements, which helps doctors keep their practices open to serve Medi-Cal enrollees, as well as the uninsured.