Word: hmos
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...also have long sent patients south. But cross-border medical HMO plans for the general population wereunheard ofuntil the mid-1990s, when Sistemas Medicos Nacionales (SIMNSA), a Tijuana-based HMO, began selling policies to employers in the San Diego area. At the time, there were no rules governing Mexican hmos selling insurance in California. "It was not legal, but it was not illegal," says SIMNSA president and ceo Frank Carrillo. "It was just sort of a gray area...
California officials decided to regulate the plans rather than shut them down and lose the benefit of low-cost health coverage in a state where an estimated 4.5 million are uninsured--more than half of them Latino. In 1998 California passed legislation that allowed Mexican HMOs to operate in the state, provided they offer benefits solely to Mexican nationals. SIMNSA was granted a license in 2000. So far, it is the only Mexican HMO approved to sell cross-border policies in California...
...widespread vaccination say it is not cost-effective given the small number of people who are actually affected. Hart challenged that assertion at yesterday’s meeting, held in the Senate reading room, saying that getting vaccinated costs around $60-70—a cost most HMOs would cover...
NCQA spokesperson Brian Schilling said he agrees shortcomings exists in a system that allows HMOs to withhold their rankings but noted the NCQA changed its policy in 1999 to require all accredited health plans to report their rankings. HMOs that are not accredited, however, still do not have to release the rankings...
With the NCQA’s policy change, the percentage of HMOs withholding rankings has been reduced to 15 percent in the past year...