PacifiCare shuffle angers doctors, patients

Art Nadler

Monday, Jan. 11, 1999 | 10:44 a.m.

Dr. Richard Nilsen had 1,300 patients last month, but by Jan. 1 he had lost them all.

Nilsen and his patients, most of whom are senior citizens on Medicare HMO through PacifiCare, have fallen under PacifiCare of Nevada's sharp restructuring ax. Neither he nor some of his patients think it's fair.

Nilsen received a termination letter dated Dec. 17 from PacifiCare. It informed him that his contract would be terminated on Dec. 31, and his patients would be reassigned to a new physician Jan. 1.

"My contract with them called for a 60-day notice, and I got one week's notice," an angry Nilsen said. "We have a lot of unhappy patients. Virtually all of my patients are over 65."

Toni Rawlins, 76, is one of those unhappy patients. She has heart and thyroid problems and has been seeing Nilsen for two years. She got a letter in December saying she could only see Nilsen until the end of this month. PacifiCare informed her that they had chosen another doctor for her.

"I have a heart and thyroid problem, and they picked a bone specialist for me," Rawlins said. "This just came out of the blue, and I don't think that it's right for them to pick a doctor without consulting with me."

Kayla Callas, director of public affairs for PacifiCare, said the company was just refining its network and that either a physician or PacifiCare can terminate a contract at any time.

She would not say how many doctors had been terminated in the latest restructuring.

"We did the best we could to give as much notice," Callas said. "We sent out letters and automatically assigned them (patients) to new primary care physicians."

Last week, PacifiCare terminated its agreement with University Medical Center's 10 Quick Care Centers, causing 7,500 customers to look for new physicians.

In September, the health maintenance organization announced that it would be ending its Medicare coverage in Laughlin and Mohave County, Ariz., on Dec. 31. This forced 3,500 customers to seek coverage elsewhere.

The Nevada State Insurance Commission had also been investigating PacifiCare this summer for not settling outstanding claims with its physicians.

Problems arose when the HMO's billing company, FPA Medical Management Inc., filed for bankruptcy in July.