(Story updated Oct. 8, 2015)
Veva Vesper sees her skin cancer surgeon, Dr. Brett Coldiron, at least twice a month to manage her delicate health condition. Coldiron was an in-network physician when Vesper enrolled in her Medicare Advantage plan last year, but she says that changed, much to her surprise.
Vesper said UnitedHealthcare dropped her physician from its network, which would have forced her to pay higher out-of-network rates for care. Other physician practices either did not accept new patients or had monthslong waits for appointments, she said, so she ultimately went back to Coldiron, who agreed to take care of her for free.
UnitedHealthcare says it has no record of Vesper being a member and that Coldiron is in-network for its Advantage plan.
“I had great anxiety trying to find another physician,” said Vesper, an Ohio resident who appeared with Sen. Sherrod Brown (D-Ohio) Wednesday as he announced he would reintroduce a bill outlawing Medicare Advantage insurers from cutting doctors out of their networks without cause during the middle of the year.
Further, Advantage plans would have to cement their provider networks 60 days before Medicare's annual open-enrollment period, which begins next week for 2016 coverage.
“We know this happens in Ohio and across the country far too often,” Brown said of Advantage plans that cull provider networks. “Seniors should know their doctors will be covered all year long,” he said.
UnitedHealthcare is the largest Advantage insurer in the country with almost 3.5 million members. “We continue to offer our Medicare Advantage members a broad choice of doctors and are collaborating with many of those care providers to transition to value-based relationships that reward quality and patient outcomes rather than the number of procedures performed,” the company said in a statement in response to Brown's news conference.
UnitedHealthcare and other insurers have previously said that federal rate cuts from the Affordable Care Act have prompted the changes in their networks. ACA-related cuts to Advantage benchmark payments end after 2016.
Brown and Sen. Richard Blumenthal (D-Conn.) first introduced the bill last year, and Rep. Rosa DeLauro (D-Conn.) pitched a House version last year as well. The Connecticut legislators are extremely familiar with the issue, which reached a crescendo last year when thousands of Medicare Advantage members in the state had their physicians dropped from their UnitedHealthcare plans—including the prominent Yale-New Haven Hospital system. Connecticut doctors and UnitedHealthcare got into a bitter legal dispute over the stripped-down networks.
Brown's bill also comes on the heels of a report from the Government Accountability Office, which said the federal government isn't doing a good enough job of ensuring Advantage plans have sufficient hospital and doctor networks. Brown and other Connecticut legislators requested the GAO report.
Richard Lieberman, chief data scientist at Mile High Healthcare Analytics who consults with Medicare insurers, said it's not uncommon to see Advantage plans trim their networks after sign-ups have ended. And it's also not uncommon to see the resulting blowback from patients who lose in-network access to their doctors.
“Narrow networks are all the rage these days, but the plans really have very blunt instruments to measure provider efficiency, so they are, at least in some cases, making stupid business decisions,” Lieberman said in an e-mail.
The CMS said this year it will keep an eye on Medicare Advantage networks and indicated willingness to fine or sanction plans that don't have adequate doctor networks or up-to-date provider directories. In 2014, the CMS also gave consumers the ability to opt out of their Advantage plans when insurers make “significant midyear provider network terminations.”
