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UnitedHealthcare discusses physician terminations with the ISMA
e-Reports, Dec. 9, 2013
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UnitedHealthcare (UHC) medical officers visited the ISMA Nov. 22 to discuss recent terminations of Indiana physicians from the insurer’s Medicare Advantage network. Officials confirmed they are not meeting with any other Indiana physician organization about this issue, though they have met with several other state medical societies since last summer when terminations began.

UHC officials reiterated that the terminations are “part of a broader initiative” to refocus their network, which according to the insurer includes 3,000 specialty and 3,000 primary care physicians. When pressed to disclose how many physicians and patients in our state are being impacted by the terminations, the medical officers advised those details were “sensitive and proprietary.”

However, subsequent to the ISMA’s meeting with UHC, the Indiana Department of Insurance (IDOI) did provide information about UHC’s network composition post terminations (as of Feb. 1, 2014); these are details that UHC submitted to the IDOI.

To see the numbers for your county go here.

The ISMA staff did confirm:

  • UHC has completed communication with its Indiana Medicare Advantage beneficiaries who should now know if their care must be transferred by Feb. 1.
  • UHC Medicare Advantage insureds do have out-of-network options. If you have been terminated, your patients can choose to remain under your care by paying a higher co-pay and you still would file insurance claims for them.
  • Physicians who receive calls from their UHC Medicare Advantage patients should advise them to contact UHC to discuss their options.
  • UHC made “proactive calls” to patients in an ongoing course of treatment, such as cancer or heart care patients or those in care coordination programs, to discuss their options under UHC’s Continuity of Care policy. Considerations are diagnosis- and episode-based and separate from any appeal by the physician.
  • Patients in an active course of treatment or their physicians can also request a review under the Continuity of Care policy.

Please share this information with your colleagues. To ascertain how many patients and physicians are being affected by these insurer actions, also respond to a brief four-question survey on our website.

Keep reading ISMA Reports and e-Reports for updates, which should be easier since the ISMA now has an appointed contact with UHC.

Additional key points from the UnitedHealthcare meeting with the ISMA:

  • Terminations were not based on performance issues; UnitedHealthcare is using the “no cause provision” in its contract for this action.
  • UHC noted contributing factors to the termination decisions were both the reduction in federal funds for the Medicare Advantage program in future years and implementation of the Star Ratings program by the Centers for Medicare & Medicaid Services (CMS).
  • Physicians remaining in the UHC Medicare Advantage network were also notified about this process, as part of the insurer’s determination of network adequacy.
  • Appeals are being handled on a case-by-case basis. UnitedHealthcare is looking for possible “care gaps” or “unique information” not available to them as they review appeals, for example, information that several colleagues in your community expect to retire soon, impacting future access to care in your area.
  • Call your network representative to provide special information that may be important to a review or appeal.
  • Read more on the UHC action by David Pittman, Washington Correspondent for MedPagetoday.com.

 

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