This is the second story this week about patients being forced to change physicians based on HMO contracts. Hope this is not a trend, especially when the government has to get involved such as the story below. BD
The California Department of Managed Health Care has reached a settlement with PacifiCare that ends, for now, a months-long saga for hundreds of Peninsula residents to find medical care after the insurer dropped physicians from its network.
And it's patients who get caught in the middle when the relationship ends between insurers and providers.
"It was almost like I didn't have any insurance," said Irene Meyer, a receptionist in a Belmont physicians' practice who had to visit the emergency department for crippling pain after her family's doctor of 17 years was cut from the network. 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.
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.
A PacifiCare representative, Cheryl Randolph (no relation to the state spokeswoman), said the insurer adamantly disagrees with the state agency's finding of fraudulent marketing actions.
PacifiCare's Randolph also said the doctors were offered an option to switch to other PacifiCare plans, enabling them to keep working with their patients. Only two doctors, she said, elected not to move to other groups.
"Nonsense," responded Dr. Sidney Marchasin, a primary care physician in Belmont who was dropped by PacifiCare.
Inside Bay Area - State intervenes in PacifiCare coverage dispute
0 comments :
Post a Comment