WSR 07-22-062



[ Filed November 1, 2007, 2:59 p.m. ]


Insurance Commissioner Mike Kreidler will conduct a public hearing on November 15 at the Best Western Executive Inn in Seattle for the purpose of hearing from Washington residents about activities that may constitute unfair methods of competition or unfair trade practices related to Medicare Advantage plans. In particular, concerns have been brought to the attention of the insurance commissioner about the availability to consumers of Medicare Advantage and other plans and access to health care providers who participate in these plans.

In late 2005, UnitedHealth Group sought the commissioner's approval for its acquisition of Pacificare of Washington, which provides Medicare Advantage plans to some 46,000 Washington seniors through its Secure Horizons products. After a hearing, the commissioner approved that acquisition on condition that United maintain the status quo of Pacificare's Washington operations until it resolved the commissioner's main areas of concern, including claims handling and provider contracts.

Since providing his conditional approval, the commissioner has received complaints that United is engaging in anti-competitive activities through its now wholly-owned entity, Pacificare of Washington. These activities are reported to include threats to terminate or adversely affect Pacificare's contracts with physicians and other health care providers unless they refuse to contract with a newly licensed entrant into the Medicare Advantage market. The commissioner is concerned that such activities may result in reduced competition in this market in Washington, displace seniors from their long-term physician relationships, and limit access for senior patients to Medicare Advantage plans and the physicians of their choice.

Under the authority of RCW 48.02.060, the commissioner may conduct hearings which are useful and proper for the efficient administration of the insurance code. The commissioner will consider all testimony and written comments* and consider whether further regulation pursuant to RCW 48.30.010 is required in order to prevent unfair methods of competition or unfair trade practices related to access to Medicare Advantage plans and the physicians and other health care providers who contract with them.

Date: Thursday, November 15, 2007
Time: 9 a.m. - Noon
Location: Best Western Executive Inn

Vashon Room

200 Taylor Avenue North

Seattle, WA

*Written comments are welcome and may be submitted to OIC legal affairs at by 5 p.m. on November 22.

Washington State Code Reviser's Office