The American Medical Association (AMA) strongly opposes United HealthCare’s (United) plan to drop Medicare Advantage providers. The AMA and over 30 other medical associations have urged a federal court to uphold a preliminary injunction barring United from arbitrarily dropping thousands of Connecticut physicians from its Medicare Advantage plan.
In October 2013, United, the nation’s largest Medicare Advantage insurer, sent letters to thousands of primary-care doctors and specialists across the country informing them that they would be dropped from its Medicare Advantage Network as of February 1. The letters often stated no basis for the termination.
Two groups of doctors—the Hartford and Fairfield County Medical Associations—submitted an emergency motion for a preliminary injunction to the District Court of Connecticut. The District Court ruled in the doctors’ favor in December; the ruling prohibits United from terminating any of the Associations’ 2,200 physician-members from United’s Medicare Advantage Network. United appealed to the Second Circuit.
In support of the preliminary injunction, AMA submitted a brief stating that United’s plans could cause irreparable harm. AMA accuses United of “disrupting physician-patient relationships and patient treatment, harming the public health of the elderly and disabled citizens of Connecticut, and harming the physicians who are members of the Plaintiff Associations.” Lifting the injunction would be “particularly problematic for the elderly and disabled patients enrolled in Medicare Advantage plans, who tend to suffer from chronic and often life-threatening conditions for which continuity of treatment is critical,” according to the AMA-supported brief.
AMA joins U.S. Sen. Richard Blumenthal, who also wrote a “friend of the court” brief on behalf of the doctors and patients of Connecticut. “Connecticut patients will immediately face the Hobson’s choice of having to give up their current physicians, thereby risking medical errors arising from lack of continuity of care, or paying much higher rates to retain their current physicians,” Blumenthal wrote. What United Healthcare is doing by dropping an estimated 2,200 doctors from its network, is “playing Russian roulette with the health of its patients.”
Jessica W. Pappas, spokeswoman for United, defended the company’s decision: “The changes that we and other Medicare Advantage plans are making will bring better health outcomes and more affordable health care coverage to Medicare Advantage members,” she said in a statement. “United Healthcare Medicare Advantage plan members will continue to have access to one of the largest physician networks in Connecticut, including nearly 3,000 primary care physicians and more than 4,400 specialists.” (Newstimes.com) Another United spokesman, Benjamin Goldstein, broadly defended the company’s decision in a message to the Hartford Curant: “With the many changes happening in health care, we are building a network of health care providers that we can collaborate with more closely to have the most positive impact on the quality of care for our members. This will encourage better health outcomes and ultimately lower costs.”
Fierce Health Payer reports that “Medicare Advantage network cuts are among payer efforts to offset $200 million in less funding over the next 10 years, initiatives that America’s Health Insurance Plans (AHIP) encouraged in a letter to Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner.” It is clear from this one case that when insurance companies cut costs, people suffer real harm. Unfortunately, sick patients who have formed relationships with their doctors and need continuous treatment will have to switch doctors in some cases.
It seemed, however, that the main sticking point against United was their lack of warning, explanation, or slight courtesy in the way they dropped their physicians. We will keep you informed on the outcome in the Second Circuit.