August 05, 2014
The California Medical Association (CMA) recently learned that United Healthcare (UHC) in April sent notices to over 800 practices that still held contracts under PacifiCare, which merged with UHC in 2006. The notice advised affected physicians that their continued participation status with UHC hinged on signing the new agreement, which includes a new fee schedule. For physicians who chose not to sign the agreement by June 15, the notification served as the required 90-day notice of termination.
UHC had first initiated a recontracting of physicians contracted with PacifiCare back in 2006 with a subsequent clean-up of missed providers in 2011. UHC has advised CMA that the latest undertaking is intended to cover any of the remaining providers that had not made the transition from PacifiCare to UHC contracts.
UHC advised CMA that no additional outreach will be made to physicians who did not respond by June 15, 2014, and by July 15, 90 days from the date of the letter, those physicians have been terminated from the UHC network. Accordingly, claims for services rendered will be processed as out-of-network.
Physicians are reminded that if they were terminated from the UHC network, their UHC patients may be eligible to request to continue to see the out-of-network physician for the completion of certain covered services under California’s continuity of care law (Insurance Code 10133.56). Patients can call the number on the back of their ID cards to inquire about whether they qualify for continuity of care. For more information about continuity of care laws, see CMA On-Call document #7051, “Contract Termination by Physicians and Continuity of Care Provisions.”
Physicians who have questions regarding the UHC recontracting effort can contact UHC at (866) 574-6088. Practices may also wish to review CMA’s “PacifiCare/United Healthcare Survival Kit,” which answers many common questions surrounding the PacifiCare transition.