ORANGE COUNTY: St. Joseph Ordered to Keep Doors Open for New PacifiCare Patients
Superior Court Judge Sheila Fell ruled Friday that St. Joseph Health System must continue to provide care, at least in the short-run, for hundreds of Orange County patients who are members of PacifiCare Health Systems, despite St. Joseph's June 29 announcement that it would decline admission to all new HMO patients. Fell issued the temporary order following PacifiCare's filed complaint that St. Joseph had violated its contract with the health plan by failing to adhere to the 90-day notification requirement for freezing enrollments. Tyler Mason, spokesperson for PacifiCare, said, "I think it's unfortunate that we had to go to court to protect our members, but we're happy with the (court's) injunction." Meanwhile, St. Joseph CFO Joseph Randolph said that they were "puzzled and disappointed that PacifiCare would take us to court rather than sitting down and talking with us" to find a solution. Officials at St. Joseph, the county's largest doctors group, explained that under the strict capitation rates regulated by managed care organizations, it is losing $45 million each year on HMO contracts. Fell's ruling affects thousands of PacifiCare members who were new to the health plan and were to become St. Joseph patients on July 1. Fell scheduled a hearing for July 26 to hear arguments on whether St. Joseph violated its contract with PacifiCare (Wolfson, Orange County Register, 7/8).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.