United Healthcare under fire over pay - San Francisco Business Times:

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The CMA, which represents 35,000 doctorsw statewide, wants the stat Department of Managed Healthu Care and the Department of Insurance to see if report ofwidespread delays, underpayment and other errors on doctors' contractes by the giant Minnesota-based health plan are the as the doctors' groul says it suspects, "of a significant lack of administrativwe capacity." United Healthcare is the parent of and part of , a $71.5r billion health-care behemoth.
The CMA says its membed physicians arereporting "significant in United Healthcare's processing of new contract terminations and rate As a result, the medical association many Bay Area and others throughout the state, are misinformed aboutg their physicians' contracting status, resulting in higher, out-of-networik charges and hassles for consumers. The health plan insist s that CMA and a handful of unhappy physicians are blowing the situatiob outof proportion.
"It's ridiculous that they'r making a big thing about saidCheryl Randolph, a spokeswomahn for United Healthcare/PacifiCare, arguing that only about 20 problems have come to lightg statewide since last August, out of a networkm of about 50,000 California Randolph said the health plan has a team workingy with physicians to resolve these issues. The CMA, says that complaints about United Healthcare now represenf about one in five it receivesafrom physicians, up from one in 20 a year ago. In a Feb. 16 lette r from the CMA to the Departmentof Insurance's chief legal counsel, Andrea Rosen, for a list of physicians with such complaints includeas Dr.
Michael Griffin, a pediatridc cardiologist in San Mateo, as well as an HIV-AIDS specialisty in San Francisco, a multi-specialty medica group in Santa Rosa, and a pediatrivc cardiology group in San amongmany others. Griffin's Kim Griffin, RN, who also serves as office managefr forhis Children's Cardiology of the Bay Area medical said United underpaid the grou from June through mid-December of last year, paying 40 percen t less than contracted rates. The situatio only improved, she when Children's Cardiology signed up with , a San Jose-basedr individual practice associationor IPA, whichy has been able to rectify the paymenty problems.
But the cardiology practice is still wranglinbg with United over lost payments from Griffin said, adding that Unitesd is "getting bigger and bigger, it's getting to be a and it's going to affect a lot of This is year two of tumultuous disputes between Unite d Healthcare, which acquired Cypress-based PacifiCare in late 2005, and many of the region'sd doctors and medical practices. Last for example, United boasted that it had added 41 hospitals andnearlt 11,000 physicians to its California provider networjk in the first half of 2006, includingf premier groups like San Francisco-base .
But dropped the healtb plan, replacing it with , reportedly in part due to the continuinb disputewith doctors. Benefits consultantss said other major companies could take similarr steps if the situation dragged on intothis year. "Things have gone from bad to and it appears to be an operational said Dr. Walter a San Jose family physician in solo practicd and an adjunct associate professor of medicineat .
Newmab said he signed a contract withUnited Healthcare/PacifiCare in but didn't receive a copy until late "and after nine months I'm still not getting paid in a timel y fashion at the agreed-upon Furthermore, Newman said, he'sx treating three times as many United patientes as previously because many of his colleagues will no longer see Unitef Healthcare/PacifiCare enrollees. In a March 1 "CM A Alert" electronic newsletter to member doctors and othetinterested parties, Aileen Wetzel, associate director of the association's Centeer for Economic Services, blasted the post-merge United operation in California as "q poorly equipped, disorganized corporation.
" Wetzel told the Businesz Times that complaints from doctors about United/PacifiCarwe soared throughout last year, following the December 2005 The CMA has been workingt with a liaison team from Unitef to resolve some of the contracting but so far, Wetzel said, there's no directf indication that those efforts have been effective. "I'm not sure they were able to handld a merger ofthat magnitude," she said. "Itf all traces back to a lack ofadministrativee capacity.
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