PACIFICARE: Offers Systemwide Independent Review Access
PacifiCare Health Systems announced this week that it will offer HMO, PPO and POS enrollees access to an independent review of medical decisions. The Independent External Review (IER) system, which officials expect to have in place by May, should provide consumers with a resolution in 10 to 30 days. "While we have always offered what we believe to be a fair and impartial appeals process with respect to medical coverage decisions, we recognize that many consumers have concerns about potential bias. The IER process ... represents a streamlined way for consumers to receive a more timely resolution of coverage decisions," PacifiCare President and CEO Brad Bowlus said, adding, "While we believe this new process will be important, we'll continue our focus on also making the health plans more accessible and easier to work with every day." The company plans to contract with several independent review boards in all nine states with plan coverage -- AZ, TX, CO, NV, OR, WA, OK, CA and OH -- to supervise the PacifiCare program and will be bound to their decision. Members unsatisfied with the review decision may appeal. The move makes Santa Ana-based PacifiCare among the nation's first managed care companies to offer a systemwide appeals program (PacifiCare release, 11/30).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.