Tuesday , May 28 2024

How Two Companies You’ve Never Heard Of May Have Disrupted Care For Thousands Californians

Every time you want to see a doctor, decisions are made about who’s in your network, what’s approved, and how much it’ll cost. Although your health plan manages everything, each of those decisions could be outsourced to a separate company—and those behind-closed-doors actions can have big impacts. Allegations of misconduct within two of these intermediary companies are already having real impacts on patients in the Valley. Last fall, Dr. Sanjay Srivatsa received a letter. Srivatsa is a cardiologist in Fresno, and the letter was from EHS, a medical group he belongs to. EHS subcontracts with health insurers and reimburses doctors like Srivatsa for seeing Medi-Cal patients. The letter was official business. “It’s a straightforward contract that just basically says we are renegotiating the price for your treatment services,” he says. But that new price was not good. For a common procedure, EHS wanted to slash Srivatsa’s payments in half for in-network patients. He could have refused, but

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