Insurance board to probe PacifiCare HMO

The Nevada State Insurance Commission is conducting a financial examination of PacifiCare of Nevada, following allegations that the health maintenance organization is not paying claims.

Guy Perkins, supervisor of the Life and Health Section of the Division of Insurance, said that a market-conduct examination will follow on July 1. At that time, the Las Vegas company will have its business activities examined, including sales and payment practices.

"We do realized we have had problems with some late claims (payments)," said Jennifer Sizemore, public affairs manager for PacifiCare of Nevada. "We are trying to resolve them as soon as possible."

One Las Vegas doctor's office said it cancelled its contract with PacifiCare for non-payment but declined to comment further.

"There seems to be a significant pattern of delinquent payments," said Lawrence Matheis, executive director of the Clark County Medical Society. "It looks like every provider (doctor's office) has had a problem.

Sizemore said the company has been giving providers partial advance payments until the problems are resolved. She said it is not unusual for the insurance commission to conduct periodic examinations of health maintenance organizations.

Frederick Waid, executive director of the Nevada Cancer Center, 1980 E. Desert Inn Road, said his clinic had had problems in the past collecting from PacifiCare, but since the HMO started using a medical management company in Arizona, payments have been made.

"Personally, I find them (PacifiCare) very willing to resolve these concerns," Waid said. "They have been more than willing to work with us."

PacifiCare of Nevada, formerly FHP Health Care, came to Nevada in 1992. Perkins said by the end of 1996, it had 44,240 commercial and 24,355 Medicare clients enrolled in the state.

PacifiCare Health Systems Inc. has headquarters in Cypress, Calif. It's traded on the NASDAQ as PHSYA, PHSYB and PHSYP.

Earnings for the quarter ending March 31 were $41 million, down from $43 million the same period a year ago. Total membership decreased 4 percent to approximately 3.7 million as of March 31, compared to 3.8 million a year earlier.

The insurance commission formed a subcommittee last month to study late payments involving other insurance companies and third-party administrators who self-insure.

Perkins said state law requires that payments be made within 30 days.

At that time, Perkins said one doctor's office in Las Vegas had between $250,000 and $300,000 in outstanding accounts receivable.

Perkins said providers or consumers having problems with health maintenance organizations not paying claims should call the Nevada State Insurance Commission at: Las Vegas, 486-4009; Carson City, (702) 687-4270 and statewide at 1-888-872-3234.

Sizemore said consumers with problems should call PacifiCare Health Systems at: 1-800-347-8600.

archive