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Medicare and Medicaid News

Judge Stops UnitedHealthcare from Dropping Physicians from Medicare Advantage Plan

Judge's order stopping last minute changes by Medicare Advantage plan in Connecticut could have national impact - open enrollment ends Saturday!

By Susan Jaffe, Kaiser Health News

Medicare Open Enrollment
Ends Dec. 7

When people with Medicare can choose plans for 2014

Click to Medicare Site

Dec. 6, 2013 - In a decision that could have national implications, a federal judge in Connecticut blocked UnitedHealthcare late Thursday from dropping an estimated 2,200 physicians from its Medicare Advantage plan in that state. The Medicare deadline for enrolling in new plans ends tomorrow, leaving little time for seniors to find plans which include their preferred physicians or switch to traditional Medicare.

While the judge’s decision affects only the physicians in Fairfield and Hartford Counties who brought suit, several other medical groups are considering filing similar actions.

“This is very good news from Connecticut,” said Dr. Sam L. Unterricht, president of the Medical Society of the State of New York.  “We will definitely seriously consider filing a suit in New York as well.”

The Ohio State Medical Association is also reviewing the decision, said Todd Baker, a spokesman for the Ohio State Medical Association.

The preliminary injunction issued by U.S. District Court Judge Stefan Underhill comes less than 48 hours before a deadline at midnight tomorrow for seniors to choose a Medicare Advantage or drug plan for next year. Medicare officials said they don’t plan to extend the deadline for beneficiaries affected by the terminations, but will continue to monitor the situation.

After the deadline, Medicare Advantage members are allowed to make one change from Jan. 1 through Feb. 14 -- they can leave their plan and rejoin traditional Medicare.

UnitedHealthcare Dropping Hundreds of Doctors From Medicare Advantage Plans

Editor’s Note: This story was reported by Susan Jaffe of Kaiser Health News and USAToday on December 1.

Dorathy Senay’s doctor had some bad news after her last checkup, but it wasn't about her serious blood disorder called amyloidosis. Her Medicare Advantage managed care plan from UnitedHealthcare/AARP is terminating the doctor's contract Feb. 1. 

She is also losing her oncologist at the prestigious Yale Medical Group -- the entire 1,200 physician practice was axed.

Senay, 71, of Canterbury, Conn., is among thousands of UnitedHealthcare Medicare members in 10 states whose doctors will be cut from their plan network. 

The company is the largest Medicare Advantage insurer in the country, with nearly 3 million members.  More than 14 million older or disabled Americans are enrolled in Medicare Advantage plans, an alternative to traditional Medicare that offers medical and usually drug coverage but members have to use the plan’s network of providers.  

"I have a rare incurable disease and these doctors have saved my life," said Senay.  "I am in good hands and I will not change doctors."

UnitedHealthcare has begun telling members about the network changes. But there is now less than two weeks before the Dec. 7 deadline for choosing new coverage next year. Timing is crucial since once they sign up, most Advantage beneficiaries are locked into their plans for the year.  Losing a doctor does not constitute an exception to the rule. Insurers can drop providers any time with 30 days advance notice to members.

(Read the rest of the story at Kaiser Health News.)

UnitedHealthcare is the largest Medicare Advantage insurer in the country, with nearly 3 million members and is reducing its network of physicians in at least nine other states  More than 14 million older or disabled Americans are enrolled in Medicare Advantage plans, a managed care version of Medicare. Generally, it is an alternative to traditional Medicare that offers medical and usually drug coverage but members have to use the plan’s providers.  

“We disagree with the ruling and intend to appeal it immediately,” said UnitedHealthcare spokesman Terry O’Hara.  However, the company will comply with the order, while the appeal is underway.  

The judge criticized the strategy to terminate the doctors: unilaterally amending the doctors’ contracts with a provision that canceled them. 

“United’s argument that it has a unilateral right to terminate participating physicians from participation in the Medicare Advantage plan by amendment of that plan is not supported by the language of the contract or the parties’ experience under it,” Underhill wrote.

The Centers for Medicare & Medicaid Services, which oversees the Medicare Advantage program, is reviewing the provider changes by UnitedHealthcare to determine whether its plans have sufficient doctors to meet federal requirements.

Neither the agency nor the insurer would discuss that review, but the Connecticut doctors argued in court that the changes would harm patients.  

“We won’t let UnitedHealthcare get away with interfering with the doctor-patient relationship,” said Dr. Robin Oshman, president of the Fairfield County Medical Association in a written statement.  The lawsuit was brought by that and the Hartford County Medical Association.

 

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Seniors advocates welcomed the ruling.

 “Judge Underhill’s decision, at a minimum, shows private Medicare plans that they do not have unfettered license,” said Judith Stein, executive director of the Connecticut-based Center for Medicare Advocacy. “Federal courts have jurisdiction over Medicare Advantage actions to ensure the beneficiary rights are protected.”

Unterricht said he hopes UnitedHealthcare will reconsider the doctors’ terminations.

“This patient population is very fragile and requires stable medical care from physicians who know them and whom they know,” he said.

Note: This report was written by Susan Jaffe (Jaffe.KHN@gmail.com), Kaiser Health News, with editing by SeniorJournal.com.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

 

Some of this information is reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery. © Henry J. Kaiser Family Foundation. All rights reserved.

 

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