How was Pacificare effected by the recent California bill enacted on health?”
Howard Phanstiel will have to contend with a lot of things beyond his control as he looks to reinvent Santa Ana-based PacifiCare Health Systems Inc. But, so far, the healthcare insurer’s new president and chief executive is getting plaudits from Wall Street for how he’s dealing with what he can control. PacifiCare’s stock, which bottomed out at around 10 in late October, has surged. Last week, it was trading at about 35-or back to where it was before Oct. 10, when PacifiCare warned that higher costs were eating into profits. As of last week, PacifiCare counted a market capitalization of $1.3 billion, up from $345 million on Nov. 1. The company got a big boost earlier this month after reporting better than expected fourth-quarter profits. And Phanstiel has laid out plans to augment PacifiCare’s core health maintenance organization business. In the works: a preferred-provider organization, a Medicare supplemental insurance offering and expanding the reach and breadth of its pharmacy bene
Health and Safety Code section 1371.4 fn. 1 generally requires health care service plans to pay for emergency medical care rendered to their enrollees, regardless of whether the provider rendering the services has contracted with the plan. Subdivision (e) of that section provides, “A health care service plan may delegate the responsibilities enumerated in this section to the plan’s contracting medical providers.” Here we conclude that a health care service plan is not statutorily obligated to pay for emergency services when it has delegated its payment responsibilities to a contracting medical provider that becomes insolvent and is unable to pay. It may, however, be liable to pay for emergency services when it has acted negligently in delegating its payment responsibilities. FACTS AND PROCEDURAL HISTORY According to allegations in its first amended complaint, plaintiff and appellant Melvin A. Ochs, M.D., Medical Corporation (Ochs), is a professional corporation that provides emergency
