Healthcare Business News

UnitedHealth terminates docs from Medicare Advantage networks

By Andis Robeznieks
Posted: October 18, 2013 - 2:00 pm ET

Even before UnitedHealth Group blamed this week's reduction in its 2014 earnings projections on Medicare Advantage payment cuts, the company began sending termination notices to physicians in some of its state MA networks, which has doctor groups in those states fuming. The company earlier in the week reported solid third-quarter earnings and an extension of its health-plan branding relationship with the senior citizen advocacy group AARP.

“The timing is questionable,” Dr. Michael Saffir, Connecticut State Medical Society president, said in an Oct. 10 news release. “This comes less than two weeks before Medicare's Open Enrollment period—how can seniors make informed decisions when their own doctors don't even know whether they're in the United network?”

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Along with those physicians in Connecticut, doctors in Florida, Indiana, New Jersey and Rhode Island also received termination letters (PDF).

Stating that it believes in “continuity of care and patient access,” the Florida Medical Association is advising its members to educate patients on how they can switch plans instead of switching doctors.

“We have received a flurry of calls from our physician members,” FMA spokeswoman Erin VanSickle said. “Physicians can tell patients that there is nothing requiring them to stay with United. In fact, patients can switch to a plan with which their physician works to maintain the relationship with that physician. The best time to do that is during their open enrollment period that began on Oct. 15.”

In a report posted on its website, the Indiana State Medical Association relayed that United's letter cited “significant changes and pressures in the healthcare environment.” The terminations there take effect Feb. 1, 2014.

The Indiana medical association's legal counsel recommends in the report that members file a written appeal immediately and raise issues of access, disruption to scheduled appointments and procedures, longevity of patient-physicians relationships and demonstrated quality, efficiency and outcomes in their appeals.

United, which reported 2013 third-quarter earnings of $1.6 billion on revenue of $30.6 billion, defended the terminations and said it would continue to offer broad choices and an expansive Medicaid Advantage network.

“Our focus is on offering access to physicians who in our view can provide quality, affordable care for more of the people enrolled in our plans,” said United spokeswoman Tracey Lempner. “Collaborating with a more focused network of physicians and other healthcare providers will help us offer higher quality and more affordable healthcare coverage for our members.”

She added that United's goals include building its network to foster more collaboration and encourage more use of primary care.

“We believe this will ultimately provide better outcomes for our members while we and others manage through severe government funding cuts and other factors impacting Medicare Advantage,” Lempner said.

The Connecticut medical society, however, accused the insurance company of “focusing on profits rather than patient care,” and declared in a statement that “United's decision jeopardizes the health of seniors by disrupting continuity of care and access to care.”

Dr. Michael Hunt, chief medical and chief medical information officer for the Bridgeport, Conn.-based St. Vincent Health Partners Physician Hospital Organization, said United's termination of physicians from its Medicare Advantage networks ran counter to AARP's senior advocacy efforts.

“How is this taking care of Medicare patients?” Hunt asked, adding that the “abrupt” terminations are not conducive to efforts within his state to promote care continuation. “That disruption violates everything we in the state of Connecticut have tried so hard to do.”

On Oct. 15, United announced it had reached an agreement in principle with the AARP to offer through the year 2020 “a portfolio of AARP-branded products” including Medicare Advantage, Medicare Part D and other Medicare supplements.

AARP spokesman David Allen acknowledged that his organization has “heard from a small number” of members regarding United's action and was encouraging “any affected member, provider, or anyone else with questions or concerns” to contact United directly using the telephone number on the back of their policy ID cards.

“Recently, UnitedHealthcare adopted a new approach to managing the provider networks for their Medicare Advantage plans to meet the specific needs of their members,” Allen said. “This includes changing the size and makeup of their provider network. While AARP is aware of these changes, we have no direct influence or control over decisions or the process itself.”

Allen added that income AARP receives from branding arrangements helps lower membership dues and is also “plowed back” into AARP programs and services to improve the lives of people ages 50 years and older.

Follow Andis Robeznieks on Twitter: @MHARobeznieks

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