Is Pacificare HMO good about paying claims? What is the general reputation of Pacificare?

I used to work in the contracting department for a medical provider. (One of the larger, national providers.) We had contracts with Pacificare, and in general they were decent to work with. Paid claims satisfactorily, were generally pleasant to work with in resolving disputes, etc. I never had any real complaints about doing business w/them.

(Never had coverage w/them as a patient - just have worked with them on behalf of a medical provider.)

Pacificare is currently in a merger with United Healthcare which is perceived negatively at this point. The industry is not in need of another 800 lb Gorilla.

The chatter on the street is that Pacific care currently has a lot of service issues related to the merger given that a lot of their top management has already been absorbed by other carriers in the area.

The HMO's however; should be least disrupted as these plans are usually cookie cutter and highly regulated by the states in which they are writen. I would assume that most of the issues will result in the member services arena and management.

I used to work for a call center answering calls for PacifiCare (of California) HMO claims department for a while. They're pretty good at paying most of their claims. However, that got a little worse after they were taken over by UnitedHealth Care. Beware though, if a problem ever arises, expect to spend MANY hours on the phone trying to resolve the issue. Their claims resolution process is not very effective IMO.

The problem is not necessarily with member services either. They contract out most of their customer service rep positions to call centers. When someone calls in with a problem, they will probably talk to someone at a call center who will try to help them as much as they can, but can only do so much. It is really up to the claims resolution department to resolve the issue, as the call center employees usually do not have the information necessary to do so. The claims resolution department hardly ever followed through on anything they were supposed to in a timely manner and to make matters worse, they would not speak directly with the members or providers themselves. This of course led to problems because we were told to tell the customers certain things (like how the issue would be resolved within a certain time period) but they would not hold up to those promises for whatever reason, creating frustration on both the customers' and member service's parts. Basically, the left hand doesn't know what the right hand is doing.

This was not the case before the merger. If the member or provider really wanted to, they could talk directly to the person handling the case. Now that is not the case. There is a huge disconnect between the company and the customers now. I don't agree with the way UnitedHealth Care handles their customers and I hope that I never have to deal with them in the future.