About 14,000 PacifiCare HMO Members Forced To Switch Physicians, Hospitals Over Failed Contract Negotiations
About 14,000 PacifiCare Health Systems HMO members will have to switch physicians or hospitals on Dec. 18, when a contract ends between the health insurer and Walnut Creek-based John Muir/Mt. Diablo Health System, the Contra Costa Times reports. Contract negotiations between PacifiCare and John Muir/Mt. Diablo ended last month without an agreement; the two sides disagreed over reimbursement rates. PacifiCare spokesperson Cheryl Randolph said that John Muir/Mt. Diablo asked for a 31% increase in reimbursement rates for hospitals and a 45% increase for physicians, rates that she said would lead to "unacceptably high" health insurance premiums for employers. "Our goal is to keep health care affordable," she said. However, John Muir/Mt. Diablo Vice President of Health Plan Contracting Mitchell Zack said, "We have financial needs that need to be met to make sure we provide high quality care." Zack added that the increased reimbursement rates that the health system requested would "bring PacifiCare in line with other plans." The lack of a contract agreement will force most PacifiCare HMO members to switch physicians, but a separate contract between the health insurer and Hill Physician's Medical Group will allow about 35% of members to retain their physicians, the Times reports. In addition, women in their second or third trimester of pregnancy can continue to receive care at John Muir/Mt. Diablo hospitals after Dec. 18 (Silber, Contra Costa Times, 12/12).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.