TDI HALTS DAILY WATCH OF INSURER

PacifiCare Health Systems Inc. is no longer under the daily scrutiny of the Texas Department of Insurance after the insurer agreed to a corrective action plan and follow-up conversations. PacifiCare has committed to spending what it takes in the next year, much of it in Texas, to upgrade its claims processing system to increase the pace at which doctors are paid, said Jose Montemayor, state insurance commissioner, in a report by The Dallas Morning News. The agency placed PacifiCare, which insures 200,000 people in North Texas, on administrative oversight in November because of concerns over quality of care, late payments to physicians and adequate access to doctors. “I’ve heard firsthand the hardship that slow payment works on providers,” Montemayor said. “Prompt pay for services rendered makes good business sense, and Texas physicians, providers and consumers deserve nothing less.” In early April, the nonprofit All Saints Hospital of Fort Worth sued the insurer for $2.5 million in unpaid claims. Two weeks earlier in a Miami lawsuit, two Texas medical associations representing 37,000 doctors joined a lawsuit that accuses PacifiCare and other major insurers of fraud, racketeering and conspiracy by systematically refusing to pay for medical treatments doctors deemed necessary. PacifiCare has declined to comment on the suits.