PacifiCare Vows Better Access to Specialists

As the annual sign-up season for workers on employer health plans heats up, PacifiCare Health Systems Inc. is joining health maintenance organizations promising enrollees better access to medical specialists.

The giant Cypress-based HMO this week kicked off marketing for its new “Express Referrals” program, which will enable primary doctors to refer plan members directly to specialists without first getting approval from their medical group’s review committee.

In contrast to competitor Blue Shield of California, which launched a specialist-referral program last summer, PacifiCare won’t require the member to pay extra to see a specialist. Blue Shield charges $30 for specialist appointments. But unlike PacifiCare, Blue Shield allows members to go directly to specialists without first being referred through the primary physician.

PacifiCare’s program, which takes effect Jan. 1, will allow referrals to specialists in 16 areas, including cardiology, urology and oncology. Chris Wing, PacifiCare’s general manager for Southern California, says medical groups normally approve referrals to such areas anyway. The program will exclude about 20 other key specialties, however, including psychiatry and certain types of surgery, he said.

In addition, PacifiCare leaves it up to the medical group to make the appointments. Though its contracts with doctors specify that members should get nonemergency specialist appointments within two weeks, Wing notes that “nothing is being promised [to members] in terms of timeliness.”

PacifiCare will include brochures explaining the program in sign-up packets for enrollees.