PacifiCare To Establish a Tiered Copayment Structure for Use of Doctors, Medical Groups
Following the industry trend of offering tiered benefits for prescription drugs and hospital care, PacifiCare is planning to divide doctors and medical groups by a similarly structured copayment system, the San Diego Union-Tribune reports. To control rising medical costs, several managed care companies are "steering" patients toward generic drugs by charging higher copayments for more costly brand-name drugs. In addition, a few HMOs have designated certain hospitals as "preferred" hospitals, charging patients much higher copays for services provided by nonpreferred hospitals. Now, PacifiCare is applying the practice to physicians and will create two categories of medical groups. Under the PacifiCare plan, HMO members who use "preferred" physicians will have lower copayments and deductibles than members who receive care from other physicians. The tiered system will only apply to members of commercial HMOs, not members enrolled in Medicare+Choice plans and Medicaid HMOs. With Blue Shield planning a similar system, health care analysts say that "such plans are here to stay," the Union-Tribune reports. Ian Morrison, a health care consultant in Menlo Park, said, "We're just beginning to see tiering with hospitals and doctors." Doctors, however, are expected to "rebel" against the tiered structure, as physicians have become "increasingly frustrated" with the "arcane rules" created by health plans. "This is just health plans riding another dead horse to improve their finances," Dr. Theodore Mazer, an ear, nose and throat specialist in San Diego, said (Fong, San Diego Union-Tribune, 3/10).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.