Everything You Wanted To Know About Your Health Plan (But Were Afraid To Ask)

It can be well worth the effort to go up against your health plan if it denies you treatment you think you need.

That’s just one of the many lessons consumers can glean by using a new online tool unveiled today by the Department of Managed Health Care.

It shows that last year, nearly two-thirds of Anthem Blue Cross enrollees who filed an appeal with the department to challenge a denial of-care ended up getting the medical services they requested. The same was true in well over half of the appeals filed by people with Blue Shield of California coverage and 45 percent of cases involving members of Kaiser Permanente, the state’s largest insurer. In some of those cases, the insurer itself decided to reverse its decision.

The department’s “health plan dashboard,” which can be found on its website, contains information pertaining only to the plans it regulates. But those plans cover 25 million Californians — nearly three-quarters of the state’s insured population.

There are many other sources consumers can use to educate themselves about insurance plans, but the Department of Managed Health Care has a wealth of data that probably exceeds any other organization’s, said Betsy Imholz, director of special projects at Consumers Union, an advocacy group.

Imholz noted that many consumers are unaware of all the information available, and it is often difficult to understand. Reporting on quality and other aspects of health care is still in a developmental stage, she said. “But our hope is that data will become better and more accessible. “This [dashboard] is a good step.”