Sunday, June 04, 2006

A UnitedHealth Contracting "Imbroglio" in California

From the San Francisco Business Times, via MSNBC comes the latest story about how UnitedHealth Group operates in the US. In California, UnitedHealth had previously used a network of physicians from Blue Shield of California, its CareTrust network, as its PPO (preferred provider organization) in that state. After UnitedHealth merged with Pacificare, it planned to end use of this network. Instead, "UnitedHealth plans to use Pacificare’s network instead and is trying to get doctors to sign a new agreement."

What was the catch? "Many are refusing, saying the new contract offers rates up to 40 percent less than UnitedHealth previously paid." So, "a number of practices in San Francisco, on the Peninsula, in the East Bay and in Marin County have declined to sign new contracts offered by Pacificare." Additionally, "the executive in charge of contracting at a Peninsula medical clinic said converting from a current UnitedHealth contract to the proposed new PacifiCare contract could cost a medical practice $15,000 per physician per year." A manager at another medical practice said, "their contract is well below our already-discounted rates. It’s pretty drastic."

Another issue appears to be that the doctors find it difficult to even communicate with UnitedHealth. A nurse who handled contracting for a pediatric cardiology practice said, "last year, I was able to get a very good contract working directly with Pacificare" Now, "it’s very disorganized, and I haven’t been able to get any phone calls returned."

Thus, "the contracting imbroglio could impact up to 900,000 UnitedHealth enrollees statewide...." "Among those who could be directly affected ... are employees at some of the region’s largest and most sophisticated employers, including Oracle, Apple Computer, Gap, Intel, Wells Fargo, PG&E, Hewlett-Packard, Morgan Stanley, and Sun Microsystems."

These are apparently more examples of the sorts of tactics used by UnitedHealth that inspired UnitedHealth board member (and Columbia University Dean of Nursing) Mary Mundinger to proclaim "We're so luck to have Bill [McGuire]. He's brilliant." (See our previous examples of such tactics here.) However, these tactics seem to conflict with the stated mission of UnitedHealth Group which includes as goals "to improve access to health and well-being services" and to "simplify the health care experience."

1 comment:

Anonymous said...

I'm in the Bay Area, working for a smaller employer, not one of those named in the article, but this is classic health insurer nonsense, trying to pay private doctors MediCal rates. Now all of the sudden, two weeks before the expiration of the contract, I'm receiving these letter notifying me that, in order to provide me with (paraphrasing) "broad access to affordable health care, expanded service," and other lines containing complete and total B.S., I will no longer be able to see several of my doctors. Rubbish. So frustrating, especially when I read things like the fact that United Healthcare made $3.3 billion in NET profits last year, and the CEO took home $1.2 billion in total compensation! And worse, there really isn't much I can do about it other than to try and spread the word.