As recently reported in CMA Alert, CMA has received a number of calls from physicians concerned about the new PacifiCare/United Healthcare contract. CMA has analyzed the PacifiCare contract and found that it in many ways violates the Knox-Keene Act.

CMA reported its finding to the Department of Managed Health Care (DMHC), and the department has given PacifiCare 10 days to modify the contract so that it complies with Knox-Keene and other regulations.

A detailed analysis of the contract, and its flaws, is available to members at the members-only website. There you will also find objective written analyses of a dozen other major health plan contracts.

CMA reminds physicians that before signing a health plan contract, it is important to know what value that relationship will bring to your practice. Physicians do not have to accept bad contracts or contracts that are not mutually beneficial.

To help physicians negotiate and manage complex third-party payor agreements, CMA has published a contracting toolkit, “Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations—A Focus on Payor Contracting.” The toolkit is available free to members at the members-only website Nonmembers can purchase the toolkit for $100 in the CMA bookstore.

Contact: Aileen Wetzel, 916/444-5532 or awetzel@cmanet.org.