Sacramento Bee

The California Department of Managed Health Care has denied a consumer group’s petition to make public the records of HMO arbitration hearings, citing its legal obligation to keep the information confidential.

Currently, the department reviews arbitration records and posts outcomes on its Web site, but many case details are omitted. While some records available on the Internet include medical information, they do not reveal the names of patients, doctors or health plans involved in disputes.

The Foundation for Taxpayer and Consumer Rights, which filed the petition 30 days ago, said patients and the public have a right to know the outcome of arbitration hearings – and which health plans and doctors are involved. That’s because most patients in managed care plans must resolve disputes through arbitration and do not have the right to sue health plans in court.

“The perils of the HMOs’ private justice system are exacerbated when secrecy shields from public view HMO quality-of-care violations uncovered in binding arbitration,” said Jamie Court, executive director of the foundation.

The group would like the Department of Managed Health Care to join them in seeking legislation next year to make arbitration records public. But Daniel Zingale, the agency’s director, said that while there are clearly some problems with the process, his goal is to see to it that HMOs are making sound medical choices for all members and learning from mistakes brought to light during arbitration.

“What we’re interested in is finding out how health plans are using results of arbitration to improve care for all patients, and we have the access we need to look at the data and make this determination,” Zingale said.