PacifiCare Physician Group Switch Leaves Fresno Members Scrambling for Doctors
PacifiCare Health Systems members in the Fresno area are "upset" about the health plan's decision to switch physician groups and are "critical" of the way the switch was handled, the Fresno Bee reports. About 61,000 Fresno members of the Orange County-based managed care organization are scrambling to find new providers following PacifiCare's decision to transfer its managed care business from Saint Agnes Medical Center and its affiliated physicians group, Matrix, to Community Medical Center and its Sante Community Physicians group. PacifiCare members were notified last week that they have until Friday to choose a physician in the Sante group, or they will be assigned to one. However, the list of Sante physicians distributed by PacifiCare was outdated and did not include more than 150 doctors who belong to Sante. In addition, only one pediatrician was on the list distributed to the managed care organization's 61,000 members. According to Scott Wells, CEO of Sante Health Systems, the list distributed to members was compiled in 1999, when the group was much smaller than the current 1,200 physicians. Wells said he was "shocked" when he saw the dated list sent to patients, and noted that he had not seen the list before it was distributed by PacifiCare. An updated list of physicians could take up to two weeks to mail, the Bee reports, but PacifiCare members must still choose a doctor by this Friday. PacifiCare officials apologized for the "abruptness of the change and its impact of members." Spokesperson Tyler Mason said, "We are doing what we believe is in the best long-term interest of providing access to care. We are trying to ease the transition as much as possible."
Meanwhile, more than 8,000 seniors enrolled in SecureHorizons, PacifiCare's Medicare+Choice plan, also must find a new physician and have been "bombard[ing]" the Fresno office of the Health Insurance Counseling and Advocacy Program with questions. Program volunteer coordinator Sam Smith "worries" that seniors, who have the option under Medicare to disenroll from a managed care plan and return to traditional Medicare, "will make a hasty decision without considering the repercussions" (Correa, Fresno Bee, 4/8).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.