New DHCS Guidance for LEAs Regarding Insurance Carrier Requests

DHCS has released a statement for LEAs who have received communication from private health insurers regarding school health service claims. Over the past year, several LEAs have reported receiving information from private insurers part as of the state’s transition to the practice of pay and chase for students with both Medi-Cal and Other Health Coverage (OHC).

On March 9, 2017, DHCS emailed the following announcement:

Update Regarding Insurance Carrier Requests:

  • The Department of Health Care Services (DHCS) was informed that a number of Local Educational Agencies (LEAs) are receiving letters from Cigna Health and Life Insurance Co. requesting students’ medical information. Typically, these letters request medical records, reports or diagnosis codes for past services the LEA provided to its students who are both Medi-Cal eligible and also have private health insurance coverage.
  • Please note that these letters are being sent in error. LEAs should not respond to these letters and may confidentially destroy them. DHCS is currently working with its partners and its third-party liability recovery vendor, Health Management Systems (HMS), to ensure that the insurance carriers seeking this type of information send their requests to the appropriate party, which in this instance would not be the LEAs.
  • If in the near future your LEA continues to receive more letters from Cigna or other health insurance carriers, please send redacted copies of the letters to LEA@dhcs.ca.gov.