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Tuesday, August 27, 2013

 

DMHC Secures Agreement with United HealthCare to Provide Medically Necessary Speech Therapy

(Sacramento) – The California Department of Managed Health Care (DMHC) announced today an agreement with United HealthCare of California and U.S. Behavioral Health Plan, California (collectively referred to as “UHC”) to end the plans’ routine denial of speech therapy services. Under the terms of the agreement, UHC must provide coverage for medically necessary speech therapy services and reimburse members who paid out-of-pocket for medically necessary therapy after those services were inappropriately denied. UHC must also revise all current health plan documents to ensure they comply with California law.

“The agreement ensures that UHC enrollees needing speech therapy will receive the care to which they are entitled to under the law,” said DMHC Director Brent Barnhart. “Enrollees will no longer have to pay out of pocket to receive medically necessary speech therapy services and can now seek reimbursement for past out of pocket expenses.”

A DMHC review of consumer complaint data identified a pattern of denials by UHC for speech therapy services on the basis that enrollees’ need for services was not due to a physical condition. California state law, known as the Knox-Keene Act, requires health plans to arrange for and cover speech therapy whenever those services are medically necessary.

The settlement, which became effective August 23, 2013, requires UHC to notify all current subscribers as part of its November 2013 subscriber newsletter, and all affected former subscribers within 60 days, of their right to medically necessary speech therapy services. The notice also will include information on how they may request reimbursement for past out-of-pocket expenses for speech therapy. A similar notice will be posted to all UHC websites within 60 days. Subscribers and former subscribers seeking reimbursement must do so prior to July 30, 2014.

For more information on the on how to obtain reimbursement for services, contact UHC’s Customer Service department at 1-800-624-8822.

Click Here to View the Official Agreement

About the DMHC

The DMHC regulates managed care health plans in California, protects the rights of approximately 20 million health plan enrollees, educates consumers on their health care rights and responsibilities, and preserves the financial stability of the managed health care system. Since 2000, the department has helped more than 1 million Californians resolve health plan problems through its Help Center. Information and assistance is available 24/7 at www.HealthHelp.ca.gov or by calling 1-888-466-2219.


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