United Healthcare Acquisition of Monarch Healthcare HMO Already Causing Confusion and Access Problems for Blue Shield Patients i
Posted Dec 03 2011 4:41pm
United Healthcare has become such a huge conglomerate in the health insurance and other Health IT industries of late and I try to keep all updated on acquisitions and mergers as best I can here with articles that I call “subsidiary watch”. So many do not realize the huge impact that acquisitions are having on care today with contracts and as everyone uses their algorithms and analytics to follow the data trails of who can go where and who can see who, we have issues. Check out the post below and take a peak at some of the numerous subsidiaries on board just for your own knowledge and to see how insurance companies are not longer just that with mergers and acquisitions. You will find that United has an industrial bank with deposits over 1 billion just as one example.
This article below is right out of the Orange County Register. Back in August, United Healthcare purchased the formerly doctor owned big HMO group. The crying towels were out and I say that due to the emails I received with doctors and hospitals not feeling very comfortable with this acquisition.
It continues on to say that a Blue Shield executive knew of 3 patients that were turned away by Monarch doctors, one of which was a cancer patient. Monarch denies this was an issue, which is usually a standard response as they have to take time and chase the contract algorithms that tell us mere humans what to do.
In addition to seeing patients the monkey appears to be on the doctor’s backs to notify their patients of the contract change, yet one more item added to the red tape and claim issues that doctors have to deal with. Monarch ran an ad, but does that reach all patients, probably not. I would not have seen it.
Blue Shield is a non-profit and United as we all now is very much “for profit” and this sounds like many patients were caught up in the dark with the new contracts and originally it was stated that there we to be no changes for patients…just let the contract do the talking for you, ok? I wonder how the transition is going for the other big HMO purchased by United, Memorial Care in Long Beach as that was a big chunk of HMO business too?
It has been tough even for employers in the OC with new United contracts since they took over Pacificare too…
In addition, recently in the news United Healthcare hired the former US Assistant Attorney General in Minnesota as a General Counsel, and again I don’t know exactly what his area of expertise or what role he will play but with all the many tiered subsidiaries that the company has I just wonder when there might be any shades of conflict of interest appear. It has been in the news that United is suing the government over a multi billion dollar Tri-Care contract they think they should have. A while back too I also found it interesting to read about how United dismisses employees when closing down a division, this too from the Orange County Register on how employees were bused to a hotel and given walking papers.
The problem with a lot of these contracts is that we are still humans needing medical care and you know what, we can’t move as fast as the algorithm changing contracts change…this is a problem not only here but all over the US. It’s like musical chairs with finding and “keeping” a provider anymore. Our poor HHS folks don’t have enough “hands on” expertise I feel at times to see this and big business eats their lunch every day, day in and day out. We need executives with some Health IT in their backgrounds to keep up with this and the current administration and their methodologies with being naïve and gullible to believing all states and numbers thrown at them is beginning to show big time and people get hurt.
In my opinion, who suckered in CMS to believe that 50% of Medicare heart and orthopedic procedures were not necessary? Who’s analytics were used to put that out this week? What non clinical expert decided to attack doctors on this topic as that is saying they don’t know their business on caring for patients, and see how this gets out there with marketing and sensationalism? I’m sure there are some as this is not a perfect world but half…again a naïve and digital illiterate believing that number tossed out there and tell the press so as well, duh?
Again with government “gullibles” out there that don’t question the math today, that’s what we end up with. I can go farther and bring in Congress here too as they are digitally illiterate and don’t’ get this either as they can’t recognize a technology tool that will help them make better laws either. The only healthcare issue that gets any real play with discussions is the “abortions filibusters” as so many live in the past who represent us. I wrote about this back in May.
In the meantime big business is investing even more with technology and algorithms and formats to help them profit even bigger…Congress had a chance to see a tool to help them with big data but couldn’t look a gift horse in the face so off to the financial and other companies the technology goes.
I said a while back that all the data mining information by corporations should be licensed and taxed and you know this is making more sense every day as big corporate conglomerates base contracts on data that they buy and sell and we as patients have to shift and move to new doctors, new pharmacies and so on. After the 1st of the year Anthem Blue Cross folks can no longer go to Walgreens for prescriptions, a contract issue once again. Walgreens by the way said their data selling business is worth just under $800 million so why does taxpayer data flow freely to allow big conglomerates to become even more powerful? That’s is what’s going on in case you have not taken notice here, and you sometimes wonder do pharmacies just fill prescriptions as a side lines business so they can capture and mine taxpayer data to sell?
Again, some of this data profiteering needs to be returned to the taxpayers who’s backs all of the millions of profits are coming from, give something back. I call it the “Attack of the Killer Algorithms” and have 6 parts written about this and you can read part 6 at the link below. This is really due for a movie or documentary to educate the public on what is happening here behind the scenes on servers that run 24/7 making life changing decisions about all of us. It is time to “Occupy Algorithms” and do it now.
Welcome to the world of discrimination by the algorithm….
Maybe Monarch will be offering the Optum/United hearing aids soon? I kind of wondered how this would sit with other insurers too with maybe using this as leverage to attract new members?
Is it this Chinese subsidiary that is making free or no cost hearing aids available?
If you want to see the back 5 parts on the Killer Algorithms, Part 5 has all the links and again time to “Occupy Algorithms” as ask questions.
So back on track here, contracts are wreaking havoc all over healthcare as people have to shift and pick and move, sometimes as this article states with “no notification” as the changes take place too fast. The article here says that they have telephone transcripts from patients with appointments being cancelled or being turned away. Smart move to to keep those on records so the patient’s voice can be heard and some of these are Medicare Advantage patients, an area where United has been pretty aggressive in working on and securing.
Blue Shield will join other networks the article continues to state and that affects 16,000 in the HMO side and 2400 in Medicare. I wonder how this will all play out with the other insurers? I guess I’ll watch the news for any further information that could arise and again as I mentioned when this acquisition occurred, there may have been very good reason for those “crying towels” that came out.
One thing for sure consistent care with providers is definitely becoming one big disrupt for all, and it comes down to the buck and this is what digital illiterate Congressmen and Key Executives allow to happen, they are out of touch with the real world. BD
Nearly 20,000 Orange County HMO patients are caught in the middle of contract dispute between Blue Shield of California and Monarch Healthcare, an Irvine-based medical group with more than 2,000 doctors.
Starting May 1, Blue Shield will no longer have a contract for its HMO patients to see Monarch's network of doctors across the county. Yet the insurer alleges that patients are being falsely told they are losing their doctors this month, and in a few cases, have been denied care.
Blue Shield on Friday released transcripts of recent calls to its customer service line from Monarch patients complaining that upcoming appointments were being canceled or they were being turned away when calling to schedule one
The dispute is the result of the sale of Monarch to a division of insurance giant UnitedHealth Group. Monarch, which was previously owned by physicians, was sold for an undisclosed amount to Optum Health on Nov. 23. Five days later, Blue Shield formally terminated the contract with Monarch, saying that the sale to a competitor violated the agreement.
Patients like Walter Price, 70, of San Clemente aren't sure what to do. He has an appointment next week with a Monarch doctor covered through his Blue Shield Medicare Advantage plan.
Days before the sale finalized, Price said he received a call at home on a Sunday afternoon telling him he would no longer be able to see his doctor. He called his doctor's office the next day.
"They didn't know anything," he said. "They had no idea. They were in the dark."
Then, Price called Blue Shield, who he says advised him to change doctors.
He's not satisfied with any of the answers he's hearing.