Fresno County Asks DMHC to Rescind Approval of New PacifiCare Contract
Fresno County has asked the Department of Managed Health Care to rescind its approval of PacifiCare of California's move to end its contract with Saint Agnes Medical Center and its physician group Matrix, the Fresno Bee reports. The managed care company's decision to switch its contract to Community Medical Centers and Sante Community Physicians means that 61,000 Valley-area members, including 2,500 county employees and retirees, likely will have to find new doctors. Fresno County Counsel Phillip Cronin wrote the department on April 6, saying, "I cannot express strongly enough the anxiety of our employees and retirees over the uncertainty of their health care and the likelihood they will lose the health services they had previously received through PacifiCare." Cronin also asked for a "full investigation" of the managed care company's handling of the situation, saying the county did not "receive adequate or timely notice" of PacifiCare's decision. State law requires that beneficiaries receive 30 days' notice of an insurer's decision to switch providers. Department Director Daniel Zingale said that approval of PacifiCare's request cannot be rescinded, adding that the agency's role is "limited to patient protection," meaning that it cannot get involved in contract disputes between insurers, doctors and hospitals.
Cronin also sent PacifiCare CEO Christopher Wing an "equally critical" letter, questioning why the managed care company waited until March 29 to inform the county of its decision, even though it had been discussing the contract change with the Department of Managed Health Care since March 19. In the letter, Cronin "suggests" that PacifiCare might have "violated" the contract it has with the county by failing to provide the mandated notice for employees to switch to new doctors, the Bee reports. But PacifiCare spokesperson Tyler Mason said the quick switch was necessary "because of serious concerns about the solvency of Matrix." He added, "Nobody is ultimately happy about the timing of this thing." The Department of Managed Health Care is taking calls from PacifiCare beneficiaries who have had "difficulty" with the switch (Correa, Fresno Bee, 4/10).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.