Reimbursement Rates Could Affect Patient Care
A "spate of mergers" in California has created "tensions over money between medical groups and large health insurers," the San Francisco Chronicle reports. While insurance companies "say mergers make them more efficient," doctors say some insurers "are flexing their muscles in contract talks," according to the Chronicle.
One such dispute involves UnitedHealth, which merged with PacifiCare Health System last year. Some San Francisco Bay Area doctors have said they will no longer contract with UnitedHealth unless reimbursement rates increase.
Several doctors in Marin County say UnitedHealth has proposed reimbursement rates that are 30% lower than previous rates. Other doctors say they will withdraw from UnitedHealth's network unless a compromise can be reached.
UnitedHealth says that its rates are competitive and that its doctor network is growing. However, spokesperson Tyler Mason acknowledged that the insurer is in contract disputes with some doctors, particularly those in areas with less physician competition.
If doctors refuse UnitedHealth's rates, some Bay Area residents might be forced to change doctors or get new coverage, the Chronicle reports (Colliver, San Francisco Chronicle, 7/26).