Unit­edHealth dumps more docs from plans

Modern Healthcare - - NEWS - By Paul Demko

Unit­edHealth Group is con­tin­u­ing to elim­i­nate physi­cians 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 pink slips. The Min­netonka, Minn.based in­surer has not dis­closed how many doc­tors it’s drop­ping in each state, but a spokesman said it ex­pects to slim its net­works to 85% to 90% of their 2013 size. Doc­tors will have the op­por­tu­nity to ap­peal. “We are tak­ing steps to sup­port our mem­bers (who) are chang­ing physi­cians, in­clud­ing help­ing to en­sure that in­di­vid­ual cour­ses of treat­ment and on­go­ing care needs are not dis­rupted,” Unit­edHealth spokesman Terry O’Hara said.

In Mas­sachusetts, Unit­edHealth said the num­bers of doc­tors in its Ad­van­tage net­work would shrink by no more than 4%. Med­i­cal As­so­ci­a­tion of Ge­or­gia of­fi­cials said Unit­edHealth told them it was cut­ting its Ad­van­tage net­work there by 10% ef­fec­tive Sept. 1. The Ten­nessee Med­i­cal As­so­ci­a­tion es­ti­mates that 500 doc­tors will be tossed ef­fec­tive Aug. 15. Russ Miller, the TMA’s CEO, said his group re­ceived no clear in­di­ca­tion from the in­surer on what prompted de­ci­sions about spe­cific physi­cians. “It sounded like they only want to do busi­ness with large groups,” Miller said.

The wave of net­work cuts continues a trend es­tab­lished last year, when doc­tors in Con­necti­cut, Florida, Mis­souri, New York and Ohio, among other states, were dropped from Unit­edHealth’s Ad­van­tage plans. In Con­necti­cut, two county med­i­cal as­so­ci­a­tions sued to chal­lenge the cuts. A federal judge in De­cem­ber granted an in­junc­tion, which was af­firmed on ap­peal, grant­ing doc­tors the right to ap­peal through ar­bi­tra­tion.

Con­gres­sional Repub­li­cans have blamed the health­care re­form law for the net­work cuts. Rep. Rosa DeLauro (D-Conn.) an­nounced she would in­tro­duce a bill to block in­sur­ers from drop­ping doc­tors in the mid­dle of an en­roll-

The wave of net­work cuts continues a trend es­tab­lished last year, when doc­tors in Con­necti­cut, Florida, New York and Ohio, among other states, were dropped from Unit­edHealth’s Ad­van­tage plans.

ment year.

De­spite the protests, John Gor­man, a Wash­ing­ton-based con­sul­tant who works with in­sur­ers, ex­pects more net­work nar­row­ing as in­sur­ers ad­just to Medi­care Ad­van­tage pay­ment cuts man­dated by the re­form law. “This has be­come do or die now for these plans,” he said.

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