In an arbitration complaint, Blue Shield claimed Monarch HealthCare agreed to be acquired by OptumHealth, a rival insurer, despite the fact Blue Shield exercised a contractual right to deny consent for the sale. Optum, an affiliate of UnitedHealth Group, acquired Monarch last November.
Juan Davila, senior vice president of network management for Blue Shield, said the insurer refused to consent to the Monarch sale because to work with a competitor “seems illogical.”
The complaint alleges Monarch also contacted brokers and enrollees about moving to other health plans from Blue Shield, also in violation of its contract. Some Blue Shield enrollees were told Monarch doctors would no longer treat them, the complaint alleged.
“We are aware of no instances of a Monarch physician declining to provide care to a Blue Shield member," said Dr. Bart Asner, Monarch Healthcare's CEO, in a written statement. "We object to the mischaracterizations made by Blue Shield.”
The insurer “has lost a majority of its Medicare members who were assigned to Monarch physicians,” the complaint said. “In addition, BSC has lost a substantial number of members who would have enrolled—but did not—with BSC but for Monarch's actions.” Monarch is the largest independent physician association in Orange County, Calif., the complaint said.
If Monarch fails to address its breach of contract by May 1, Blue Shield will terminate its contract, the complaint said.