CMA this week learned that the Department of Insurance (DOI) and the Department of Managed Health Care (DMHC) have launched an investigation of PacifiCare/United Healthcare. This announcement comes just a few months after CMA informed state regulators that the association had been receiving a large number of complaints from physicians about the insurer, particularly with regard to physician contracting and urged them to investigate.

Among the complaints were 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 and payment delays 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.

“We are looking into a wide range of conduct by these companies and will use the full array of investigative and enforcement mechanisms available to us,” wrote David Link, DOI deputy commissioner, and Ed Heidig, DMHC deputy director, in a letter to CMA.

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