California radiologist group sues UnitedHealthcare over payment rates

The lawsuit echoes other widespread grievances against the insurer.

By Amy Lynn Sorrel, AMNews staff. July 2, 2007.

A radiology group in California has taken UnitedHealthcare to court after nearly a year of unsuccessfully wrangling with the insurance giant to honor PacifiCare Health Systems' contract rates it took over when the companies merged two years ago.

Radiological Associates of Sacramento Medical Group Inc. sued United in June for allegedly shortchanging the practice on payments for services it agreed to cover fully under a 2003 PacifiCare contract.

"If we didn't do something and acquiesced to a unilateral reduction in our payments, what would be next?" Radiological Associates Executive Vice President Fred Gaschen said. "If one company does it, pretty soon it's two, then it's 10."

California insurance regulators, meanwhile, also are putting the heat on United in light of a host of complaints that the California Medical Assn. began reporting to the state in February. Aileen E. Wetzel, associate director of the CMA's Center for Economic Services, said that following the United-PacifiCare merger, doctors "encountered a poorly equipped, disorganized corporation."

Among the complaints against United and its PacifiCare subsidiary, she said, are delays in processing new contracts and terminations, as well as failures to correctly input doctors' contract rates into their system -- all of which have resulted in reduced and delayed payments. In addition, she said there has been misinformation to patients about their doctors' participation status in either plan.

Though the CMA has worked with United to help resolve doctors' individual issues, "it does not appear that [United] has made a commitment to eliminating these problems on a systemic level," Wetzel said.