Why does Medi-Cal reimburse Kaiser at such a low rate?
The reimbursed dollars are not always the best indicator of what was actually dispensed. Other Health Coverage or Third Party Liability (TPL) information may not always be entered as part of the Medi-Cal claim. It is normal to see Kaiser Permanente claims for their fee-for-service Medi-Cal patients being reimbursed for a co-pay of $5 – $30 with no TPL data. For that reason, most Kaiser claims are correct and the units are correctly invoiced for rebates.
