The ISMA has started fielding calls from physicians who have recently received letters notifying them that they have been unilaterally terminated from the UnitedHealthcare Medicare Advantage network. The letters state that there are “significant changes and pressures in the healthcare environment,” and that the terminations will take effect on Feb. 1, 2014. However, physicians can remain in all other United networks. Similar letters have been sent across the country.
At press time, the ISMA had made several calls to United seeking more details. Also, the ISMA has been in discussions with the Indiana Department of Insurance, which is investigating the matter.
Additionally, the ISMA has attempted to contact the Centers for Medicare & Medicaid Services, but its staff is currently furloughed because of the federal government shutdown.
“Physicians who are unhappy with their terminations can appeal and should do so immediately, in writing,” advised Julie Reed, ISMA legal counsel.
The letters, dated Oct. 2, state the appeal deadline is 30 days from receipt of the termination notice, so time is of the essence. Issues to be raised on appeal depend on each physician’s circumstances, but could include:
- Access to other physicians in the same practice area
- Impact on the practice and its patients
- Disruption to future scheduled appointments and procedures
- Longevity of the patient/physician relationships
- Physician education, expertise and unique services
- Demonstrated quality, efficiency or outcomes
A United spokesperson indicated to the ISMA that some appeals have been successful.
Watch ISMA Reports and the ISMA website for information as it becomes available. For more information, contact the ISMA’s Legal or Practice Management departments at (317) 261-2060 or (800) 257-4762.