Healthcare Business News

UnitedHealth continues to cut Medicare Advantage providers

By Paul Demko
Posted: June 16, 2014 - 3:45 pm ET

UnitedHealth Group is continuing to eliminate doctors from its provider networks for Medicare Advantage plans in states across the country.

In recent weeks, doctors in Alabama, Georgia, Massachusetts, North Carolina and Tennessee have received notifications that their services will no longer be covered for patients with United plans.

The Minnetonka, Minn.-based insurer is not releasing how many doctors are being eliminated in each state. But a spokesman indicated that the company expects to pare its networks down to 85% to 90% of their 2013 size. Doctors will have the opportunity to appeal the decision.

“It is important to note that we are taking steps to support our members that are changing physicians, including helping to ensure that individual courses of treatment and ongoing care needs are not disrupted,” United spokesman Terry O'Hara wrote in an e-mail.

Mark Jackson, executive director of the Medical Association of the State of Alabama, said it's unclear how many doctors are affected in that state. “The information's just beginning to filter in to us in the last week or two,” he said “Obviously, a lot of physicians are not happy about it.”

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In Massachusetts, United indicated that the numbers of doctors in its Medicare Advantage network would be reduced by no more than 2% to 4%. That means the 18,600 providers in the network could be reduced by as much as 744 physicians.

The Medical Association of Georgia said United officials told them the Medicare Advantage network would be reduced by 10%, effective Sept. 1, with most of the cuts coming in the Atlanta, Columbus and Augusta markets.

The Tennessee Medical Association estimates that 500 doctors will be eliminated from its Medicare Advantage network effective Aug. 15. “We understand that this may be of concern to you,” states a letter sent to targeted doctors. “We are ready to answer questions you have, hear your concerns, and help your patients access necessary care with their plan's network.”

Russ Miller, CEO of the Tennessee association, said the organization talked with United officials about the cuts, but was given no clear indication about what prompted the decisions to eliminate specific physicians. But he suspects that solo practitioners are disproportionately impacted.

“It sounded like we only want to do business with large groups,” Miller said. “That's exactly what it sounded like to me.”

The wave of provider cuts continues a trend that was established last year, when doctors in Connecticut, Florida, New York and Ohio, among other states, were eliminated from United's network.

In Connecticut, the Fairfield County Medical Association and the Hartford County Medical Association filed a lawsuit challenging the elimination of doctors. A federal judge in December granted an injunction, which was affirmed on appeal, granting doctors the right to appeal the decision through an arbitration process.

The cuts also have sparked an outcry from some members of Congress. Republicans have called the cuts evidence that the Patient Protection and Affordable Care Act, which included reduced spending on the Medicare Advantage program, is preventing seniors from seeing their preferred doctors.

Rep. Rosa DeLauro (D-Conn.) announced plans to introduce the “Medicare Advantage Participant Bill of Rights Act,” which would prohibit plans from dropping doctors in the middle of the year.

Despite the protests, John Gorman, a Washington-based consultant who works with insurers, expects more cuts to networks as plans adjust to lower Medicare Advantage payments.

“What we saw in Connecticut was just the beginning of a trend,” he said. “And not just for United, but just about for all multi-state carriers. This has become do or die now for these plans.”

Follow Paul Demko on Twitter: @MHpdemko

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