HMO pledges to pay old claims to doctors

Art Nadler

Wednesday, Aug. 26, 1998 | 10:50 a.m.

PacifiCare of Nevada has pledged to settle all its outstanding claims with physicians by Oct. 15, a representative with the Nevada State Insurance Commission said Tuesday.

Guy Perkins, supervisor of the Life and Health Section, said officers of the health maintenance organization met with him on Monday. The company agreed to compensate doctors who were never paid when FPA Medical Management Inc., PacifiCare's billing company, filed for bankruptcy in July.

Perkins said doctors have been calling the insurance commission since FPA's demise, complaining that PacifiCare hasn't been making payments as promised after taking over.

Ross Newman, chief executive officer of Innovative Healthcare Inc., said he had made several phone calls to PacifiCare's director of provider services, and they weren't returned.

Newman maintains that the HMO underpaid his practice by underestimating the number of patients being treated.

"I think they got administration overload," Newman said. "They may not have intentionally denied payments, but they did not do the best job after the meltdown of FPA."

Newman said his calls were finally returned Monday, and a meeting has been scheduled with PacifiCare's director of provider services on Friday.

"We will know in the next couple weeks if they are telling the truth," a skeptical Newman said of promised payments. "They always say good things."

Bob Lawrence, administrator for the Cardiovascular Center of Southern Nevada, said his office is owed more than $1 million. He terminated his agreement with PacifiCare on June 26. He said some of the debt dates back to 1997 and includes all of 1998 to date.

Kayla Callas, director of public affairs for PacifiCare of Nevada, said the HMO was prohibited by the U.S. Bankruptcy Court in Delaware from paying FPA's providers. She said PacifiCare went to the court on Aug. 20 and had the order modified, so the company could start compensating physicians.

"We intend to resolve the FPA matter by Oct. 15," Callas said.

She said a full-page advertisement in Sunday's newspaper was meant to dispel any concerns that PacifiCare might go bankrupt.

"The notion that PacifiCare is going bankrupt is absurd," Callas said. "The peace of mind of our members is our top priority. The intention of this ad was to assure our financial stability and our commitment to Nevada."

Perkins said the insurance commission is convinced that PacifiCare has a "good, workable plan in place." He wants physicians to remain patient and call the insurance commission if they have further concerns.