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

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The CMA, which represents 35,000 doctore statewide, wants the state Department of Managed Health Care and the Department of Insurancde to see if reports of widespread underpayments and other errors on contracts by thegiant Minnesota-baser health plan are the as the doctors' group says it suspects, "otf a significant lack of administrative United Healthcare is the parent of and part of , a $71. billion health-care behemoth. The CMA says its member physicianzs arereporting "significant delays" in United Healthcare'xs processing of new contracts, contracgt terminations and rate changes.
As a result, the medicapl association says, many Bay Area patients, and otherz throughout the state, are misinformed aboutf their physicians' contracting status, resulting in out-of-network charges and hassle s for consumers. The health plan insists that CMA and a handful of unhappyg physicians are blowing the situation outof proportion. "It' ridiculous that they're making a big thing about saidCheryl Randolph, a spokeswoman for United Healthcare/PacifiCare, arguing that only about 20 problems have come to lighr statewide since last August, out of a network of aboutt 50,000 California physicians.
Randolph said the healtj plan has a team working with physicians to resolve these issues. The CMA, says that complaints about United Healthcare now represenft about one in five it receivesfrom physicians, up from one in 20 a year ago. In a Feb. 16 lettet from the CMA to the Departmentof Insurance'sd chief legal counsel, Andrea Rosen, for a list of physicians with such complaints includes Dr. Michaelk Griffin, a pediatric cardiologist in San as well asan HIV-AIDz specialist in San Francisco, a multi-specialty medical group in Sant Rosa, and a pediatric cardiology group in San Jose, among many others.
Griffin's wife, Kim RN, who also serves as office manager forhis Children's Cardiology of the Bay Area medica practice, said United underpaid the groupl from June through mid-December of last paying 40 percent less than contractef rates. The situation only improved, she said, when Children's Cardiology signed up with , a San Jose-basesd individual practice associationor IPA, which has been able to rectifh the payment problems. But the cardiology practicde is still wrangling with United over lost paymentwfrom 2006, Griffin said, adding that United is "getting biggef and bigger, it's getting to be a monopoly, and it'z going to affect a lot of people.
" This is year two of tumultuouds disputes between United Healthcare, which acquired Cypress-based PacifiCare in late 2005, and many of the region's doctors and medicakl practices. Last October, for United boasted that it had addec 41 hospitals andnearly 11,000 physiciansd to its California provider network in the firsyt half of 2006, including premier groups like San Francisco-basee . But dropped the health plan, replacinf it with , reportedly in part due to the continuintg disputewith doctors.
Benefits consultants said other major companies coulds take similar steps if the situation dragged on intothis "Things have gone from bad to and it appears to be an operationall issue," said Dr. Walte Newman, a San Jose familgy physician in solo practice and an adjunc associate professor of medicineat . Newman said he signedr a contract withUniter Healthcare/PacifiCare in October, but didn't receive a copy until late February, "and after nine months I'm stilk not getting paid in a timely fashion at the agreed-uponj rate.
" Furthermore, Newman said, he's treating threes times as many United patients as previouslyu because many of his colleaguesd will no longer see United Healthcare/PacifiCare enrollees. In a Marchu 1 "CMA Alert" electronicc newsletter to member doctors and other interested Aileen Wetzel, associate director of the association's Center for Economid Services, blasted the post-merger United operatio n in California as "a poorly disorganized corporation." Wetzel told the Business Timews that complaints from doctors abouf United/PacifiCare soared throughout last following the December 2005 merger.
The CMA has been workin with a liaison team from Unitexd to resolve some of thecontractiny problems, but so far, Wetzel said, there'sw no direct indication that those effortzs have been effective. "I'm not sure they were able to handlde a merger of that she said. "It all tracesa back to a lack ofadministrativr capacity."