Keep your insurance and lose your doctor
State steps in to defuse PacifiCare controversy
By Suzanne Bohan
San Mateo County Times
June 30, 2007
The California Department of Managed Health Care has reached a settlement with PacifiCare that ends, for now, a months-long quest for hundreds of Peninsula residents to find medical care after the insurer dropped physicians from its network.
Last week’s settlement follows the first cease-and-desist order the managed health care department has issued for deceptive marketing practices, said Lynne Randolph, spokeswoman for the state agency. The Department of Managed Health Care, which formed in 2000, serves as a watchdog for patients enrolled in HMO plans.
The May 17 cease-and-desist order found that more than 500 people enrolled with a small physicians’ group associated with Sequoia Hospital in Redwood City were “deceived, or otherwise misled” into believing their primary care doctor was still part of PacifiCare’s network when they enrolled or re-enrolled with the insurer last fall.
In fact, the order states, the insurer knew more than a year before the patients signed up that it planned to terminate its contract with the small physicians’ group.
The order requires that PacifiCare allow the patients to immediately return to their original physician until the next open enrollment period in the fall. At that point, they’ll still need to find either a new health plan or a new primary care physician.
An enforcement official with the managed care department said notification wasn’t the issue; the enforcement order was solely focused on the insurer’s failure to notify patients that their physicians were already dropped from the network when they signed up with PacifiCare.
http://www.insidebayarea.com/sanmateocountytimes/localnews/ci_6269556
Comment:
By Don McCanne, MD
Single payer opponents claim that the government would take away your choice of physician under a program of national health insurance. But do you lose your choice in the traditional, government-run Medicare program? Only if you sign up for a private insurance plan through Medicare Advantage are you limited in your choices of physicians.
Why do we continue to pay private insurers outrageous administrative fees for intrusive, wasteful services such as taking away our choice of physicians? A government program would never waste administrative funds on enforcing policies that serve to the detriment of patients.
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