The Texas attorney general's office Feb. 18 filed a lawsuit against PacifiCare of Texas, accusing the health insurance company of not paying some physicians in a timely manner and not paying others at all.Attorney General John Cornyn said the company's actions violated the Texas Health Maintenance Organizations Act and Deceptive Trade Practices Act and have resulted in millions of dollars in unpaid claims, disrupted patient care and unresolved complaints.
PacifiCare, which is based in Santa Ana, Calif., said that the lawsuit has no merit.
"PacifiCare has acted responsibly and promptly in this matter," the company said in a statement. "At this time, it is paying claims on an average of five days and is in compliance with TDI (Texas Department of Insurance) regulations regarding complaint resolution."
Three of PacifiCare's providers-Heritage Southwest Medical Group in Dallas, Quantum Southwest Medical Management in San Antonio and Medical Select Management in Fort Worth-have recently filed for bankruptcy.
"PacifiCare has repeatedly promised to clean up its act, but it has not done so," Cornyn said. "We're now asking the court to order PacifiCare to do business the way it should under Texas law and to make it pay for its violations. If PacifiCare wants to be in the health care business in Texas, it must play by the rules."
The lawsuit was supported by the Texas Medical Association, which also contends many health care providers do not pay physicians promptly.
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