Blue Shield of California and Monarch HealthCare are accusing each other of “misleading” Orange County patients about availability of coverage next year.

At issue is the length of time Blue Shield coverage will continue for patients whose doctors are part of the Irvine-based Monarch HealthCare group.

Blue Shield issued a news release Thursday asserting  that Monarch is falsely telling about 20,000 Blue Shield commercial and Medicare patients they must immediately switch health plans to keep their current doctors.

But Blue Shield stated its Orange County members may continue to use Monarch doctors through May 1, 2012. Monarch erroneously told the patients their Blue Shield coverage would end Jan. 1, according to the release. It added that Blue Shield is preparing to sue Monarch.

In response, the Monarch doctors medical plan issued its own statement Friday that stated if “HMO members want to be certain they can see their Monarch doctors throughout all of 2012, it is important that they know they have the freedom to enroll in one of the many leading health plans that work with Monarch.”

The statement by Executive Chairman Dr. Jay Cohen warned Monarch’s Medicare patients they have until the Dec. 7 open enrollment deadline to switch plans.

According to Blue Shield, the issue began last month when Monarch was bought by OptumHealth, an affiliate of Minnesota-based UnitedHealth Group. According to its website, Monarch is “Orange County’s largest association of physicians in private practice.”

From the Blue Shield news release:

Even before the deal between Monarch and United was completed, numerous members began contacting Blue Shield indicating that Monarch physicians were refusing to make appointments with them.

Other members have reported receiving recorded telephone calls indicating they must change health carriers by Dec. 7, 2011, or lose access to their Monarch-affiliated physician. Monarch has also placed misleading advertisements in local newspapers. These actions have confused and frightened patients, and are clear violations of Monarch’s contract with Blue Shield. In light of these breaches, Blue Shield is preparing to take legal action against Monarch.

Blue Shield asserted that Monarch assigned its contract to UnitedHealth without Blue Shield’s permission after the medical group was bought by UnitedHealth.

“Monarch effectively breached the contract,” stated the news release.

But Monarch blamed Blue Shield. Here is what Monarch had to say:

We are acting in our patients’ best interests to ensure they know about this threat to their relationships with the doctors they trust and to make them aware that they have options to maintain those relationships. …

Unfortunately, Blue Shield has decided to end its relationship with Monarch’s doctors for reasons that place its business interests above those of its members. By not clarifying timing of the termination for its members until just days prior to the end of open enrollment period for 2012, Blue Shield has put severe time pressure on the many patients who want to be certain they can keep their doctor throughout 2012.


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