Managed Care Matters

Single-payer advocates have won another skirmish in the battle over health care reform, while those in favor of reform based on the existing insurance marketplace (that would include your author) are once again trying to explain why big insurance companies screw up so badly so often.

An audit by the California Insurance Department and Department of Managed Health Care found that Pacificare routinely mishandled claims and customer inquiries, with 'routinely' defined as about one-third of the time.

For those (including me) forever excoriating health systems and hospitals for their outrageous error rates, the debacle at Pacificare, the recently-acquired division of United Healthcare (one of my past employers) make the delivery sector look like a paragon of performance. I'm not overly surprised, as mergers involve systems conversions, the amalgamation of provider networks and contracts, and the shifting of work around to different call centers and processing locations. Duplicate staff positions are identified and people laid off, and when they walk out the door so does the expertise and understanding that enabled the operation to run smoothly.

Some will argue that this is a temporary hiccup, that any merger of this type and size will inevitably result in problems. All true, as is the point that they could not be screwing up at a worse time - during an election year wherein the future of their business will be determined.

So far, the private sector is not making much of a case.

Thanks to California Healthline for the tip.