CMA in February informed state regulators that administrative delays by PacifiCare/ United Healthcare (PC/UHC) were negatively impacting patient access to care. CMA 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.

CMA had received a number of complaints from physicians of insurer’s 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.

Although CMA has worked with the insurer to resolve individual physician complaints, it does not appear that PC/UHC has made a commitment to eliminating these problems on a systemic level. CMA continues to receive similar complaints from other physicians on a daily basis.

CMA last week reiterated its concerns to DMHC and DOI and strongly urged them to conduct a formal investigation into this matter. Additional details will be published in CMA Alert as they become available.

Contact: CMA’s reimbursement help line, 888/401-5911 or awetzel@cmanet.org.