This was brought about by the Department of Managed Care as California has 2 entities that over see health insurance. This division is specific to monitoring HMOs. With the new agreement patients will be given the care they need for speech therapy when it is medically needed and many were improperly denied over the years. Routinely United has denied requests from members.
Consumer complaints brought this to light with identifying the patterns of denial. Patients basically have a year to request reimbursement where they have had to pay out of pocket. BD
The Department of Managed Health Care announced Tuesday it has reached an agreement with UnitedHealthcare to end routine denial of speech therapy services requested by members.
Terms of the agreement require the health plan to provide coverage for medically necessary speech therapy services and reimburse members who paid out-of-pocket for these services after they were inappropriately denied. UnitedHealthcare also must revise all current health plan documents to ensure they comply with California law.