CMA has received a number of calls from physicians complaining about administrative delays by PacifiCare/United Healthcare, particularly in regard to physician contracting. The delays are causing significant confusion as to physicians’ participation status and negatively impacting patient access to care.

Among the complaints are charges of chronic delays processing new contracts and contract terminations. These delays not only have caused patients to be misinformed about physicians’ participation status, but also have resulted in significant administrative hassles for physician offices. Physicians are also reporting that the insurer has failed to load contracted rates correctly and has been unresponsive to their phone calls, letters, and e-mails.

CMA has asked the Department of Managed Health Care (DMHC) and the Department of Insurance (DOI) to investigate the situation and determine whether the delays are the result, as CMA suspects, of a significant lack of administrative capacity.

“After the PacifiCare/United Healthcare merger, physicians in California encountered a poorly equipped, disorganized corporation,” wrote Aileen E. Wetzel of CMA’s Center for Economic Services in a letter to DMHC and DOI.

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