California Medical Association Says State Regulators' Actions Against UnitedHealth/PacifiCare Encouraging, But Bad Behavior By Insurers Must Stop

Main Category: Health Insurance / Medical Insurance
Article Date: 30 Jan 2008 - 13:00 PDT

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Fines announced against UnitedHealth/PacifiCare in response to CMA complaints on behalf of doctors and patients send an important message to health insurers that their misdeeds have consequences, but the CMA called upon regulators to be continually vigilant in protecting patients.

"We are encouraged that California's two regulatory agencies have taken the important step of banding together to tell United/PacifiCare enough is enough," said Richard Frankenstein, M.D., president of the California Medical Association, which asked regulators to investigate the insurance company early last year. "For-profit health plans have made billions of dollars in California by putting profits ahead of patients. Just because United said they're sorry and will pay fines, it doesn't mean patients are protected and won't continue to suffer. These fines won't give them back their money or their health."

Since the United PacifiCare merger more than two years ago, there has been great chaos for doctors and patients. The insurance company was not able to keep track of the patients it insured and the doctors with whom it had contracts, creating a bureaucratic nightmare for patients and doctors at best, potentially costing patients access to health care at worst. United's poor administrative practices affected thousands of patients who in some cases went without care or lacked continuity of care.

Meanwhile, United profits nationwide continued to soar and its top officials collected billions of dollars in salary and other benefits.

The CMA had publicly opposed the United/PacifiCare merger from the beginning, saying it would be a detriment to patient care, yet United officials have used the merger as an excuse for their inefficiencies and errors.

"UnitedHealth has bought up little and big health plans all over the country," said Dr. Frankenstein. "If they weren't prepared to manage that business from day one, they shouldn't have done it."

Doctors and patients from throughout the state complained to CMA about problems with United, including patients being told erroneously that they would have to switch doctors, or that their doctors were out of network when they actually were not. Patients were told they had different coverage than they signed up and paid for, and were given lists of doctors in network that were very outdated. The mistakes caused delays and denials of patient care. CMA passed the many complaints on to regulators.

The California Medical Association represents 35,000 California physicians in all modes of practice and specialties.

California Medical Association