LOS ANGELES -- Maribel Pantoja sat nervously on a papered examination table awaiting word from her doctor about a painful ulcer wound on her left leg.

Because she only speaks Spanish, there is usually an added level of anxiety when she visits a clinic. But thanks to a new state law that requires her health insurer to provide a translator, Pantoja on Tuesday was spared the confusion of trying to communicate with her doctor.

Her nervous face relaxed when she peered on a computer screen equipped with a webcam, and saw a translator peering back. After patient and translator greeted each other in Spanish, the nurse asked questions and Pantoja answered.

Afterward, Pantoja said quietly in Spanish that the webcam made her visit to Los Angeles County-USC Medical Center better than the rest. She actually understood every word.

That's precisely the goal of the law that took effect Jan. 1, making California the first state to require health insurance plans to provide translators for their members with limited English skills.

Under the law, which was passed in 2003 but endured several delays, health insurers are required to provide patients who lack English comprehension with an on-site translator or access to one through telephone or web-hosted videoconferencing.

"There are people who say that those people should just learn English, but we can't let people be pushed out of health care because of language barriers," said Cindy Ehnes, director of the state Department of Managed Health Care.

The state's diversity is cited as a reason for its torch-bearing role: 42.6 percent of Californians do not speak English at home, according to 2007 census figures. In some populations, such as Vietnamese and Korean communities, 60 percent of the population has limited English proficiency.

Ehnes said that although many non-English speakers pay for health insurance, in the past they've faced problems receiving health care because of language and cultural barriers, waiting longer for care and lesser service.

In one case, Ehnes said, a woman who lacked English skills wasn't diagnosed with breast cancer until the disease had spread to other parts of her body, because early visits to the doctor only resulted in confusion.

An estimated one-third of the 21 million HMO and PPO members in the state could benefit from the law, according to the department. Since 2006, the regulator has received 343 complaints from health plan members who said a language or cultural barrier has hindered their medical care.

The new law also requires health plans to translate their standardized documents into the top two languages spoken by their members, typically Spanish and Mandarin or Cantonese.

Though it's expected to increase costs for health plans, the new law was welcomed by the California Association of Health Plans, a group that lobbies for insurers.

"We needed to find ways to make this a practical thing for health plans to do," said spokeswoman Nicole Kasabian-Evans, noting that keeping bilingual staffers in some rural areas would have presented an insurmountable burden without teleconferencing.

The California Pan-Ethnic Health Network, which sponsored the law, said it was supposed to be implemented by January 2006 but faced delays, partly because of staffing changes in the regulators' office, the 2006 special election of Gov. Arnold Schwarzenegger and his subsequent moratorium on the law due to budgetary concerns.

Dr. Elaine Batchlor, chief medical officer for the L.A. Care Health Plan, the country's largest public health plan, said the provider has voluntarily provided translation for years, long before the law was enacted, and provides the services to Medi-Cal and nonpaying patients as well.

"You cannot provide effective health care without interpretation, and we're trying to meet the needs of our members, who speak different languages and have different needs," Batchlor said.

Last year, it cost $500,000 for L.A. Care to provide translation services for 80,000 policy holders, costing between $150 and $250 per hour of translation, depending on the language.

Statewide, early estimates from health insurers said the law would cost insurers a combined $25 million to implement, though actual costs may vary widely from insurer to insurer.

Language Line Services, a translation services provider, said its top 10 requested foreign languages in California in 2007 and 2008 were Spanish, Cantonese, Mandarin, Vietnamese, Korean, Russian, Farsi, Arabic, Punjabi and Tagalog.