As California continues toward implementation of federal health care reform, efforts to contain health care costs have become increasingly critical, and all parties to the health care delivery system share responsibility. California health insurers, however, have implemented many procedures and protocols under the guise of cost containment that threaten the doctor-patient relationship and interfere with effective patient care by denying or delaying patient treatment. These practices carry innocuous-sounding names, such as “prior-” or “pre-authorization,” “pre-approval,” or “step edits,” but the impact can be anything but innocuous.