PacifiCare Reaches Settlement With California Regulators
The Department of Managed Health Care last week reached a settlement with PacifiCare that will permit some PacifiCare members to continue to see their primary care physicians who have been dropped from the health plan's network, the San Mateo County Times reports.
The agreement comes after DMHC on May 17 issued a cease-and-desist order to PacifiCare, concluding that more than 500 members had been "deceived, or otherwise misled" about the status of their primary care physician's participation in the health plan.
Cheryl Randolph of PacifiCare said the company disputed the order's findings, maintaining that proper notice had been given to members about the physicians' inclusion in the PacifiCare network.
The doctors in question are members of a small physicians' group affiliated with Sequoia Hospital in Redwood City.
A DMHC enforcement official said the action was not about PacifiCare's compliance with a state notification rule but instead stemmed from PacifiCare's not informing members that the physicians already had been dropped from the network when the members enrolled or re-enrolled.
Under terms of the settlement, PacifiCare members will be allowed to continue to see doctors from the dropped physicians' group until the plan's next open enrollment period in October (Bohan, San Mateo County Times, 6/30).