After receiving a number of physician complaints, CMA earlier this year analyzed the PacifiCare/United Healthcare physician contract and found that it in many ways violated state laws and regulations, including the Knox-Keene Act.

CMA reported these findings to the Department of Managed Health Care (DMHC), and the department gave PacifiCare 10 days to modify the contract so that it complied with state laws. Although PacifiCare did make some changes to the contract, CMA continues to have concerns with its provisions.

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.

For more information, see “Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations—A Focus on Payor Contracting.” This toolkit is available free to members at the members-only website Nonmembers can purchase the toolkit for $100 in the CMA bookstore.

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