An independent medical review completed by the department required Blue Cross of California Partnership Plan, a managed Medicaid plan, to cover consultation services for transgender-related procedures requested by two of its Medi-Cal enrollees.
While Blue Cross was immediately informed about the department’s independent medical review that found the services to be medically necessary, Blue Cross didn’t authorize the coverage quickly enough. Under California law, health insurers have five days to authorize services that are deemed medically necessary by the department, but enrollees said they still had trouble accessing covered services months after the department’s determination.
Blue Cross agreed to the fine and updated its internal policies.
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