December 09, 2013
2 min read
Save

Judge bars UnitedHealthcare from dropping Medicare Advantage network physicians

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

A federal judge has agreed to a request by two Connecticut medical associations to temporarily block UnitedHealthcare from terminating physicians from its Medicare Advantage plan network.

Medical associations in Fairfield and Hartford counties filed a legal challenge in November to block UnitedHealthcare from terminating as many as 2,250 physicians, which the associations estimate is approximately 20% of the company’s Connecticut physician network.

“We won’t let UnitedHealthcare get away with interfering with the doctor-patient relationship,” Robin Oshman, MD, president of the Fairfield County Medical Association, said in a statement responding to the judge’s decision. The associations contend that UnitedHealthcare’s decision also could impact as many as 20,000 to 30,000 Medicare patients.

The judge’s decision also prohibits UnitedHealthcare from notifying beneficiaries that certain providers will be terminated and from removing or failing to advertise affected physicians in its 2014 provider directories.

UnitedHealthcare quickly announced it will appeal the decision.

“We believe the court’s ruling will create unnecessary and harmful confusion and disruption to Medicare beneficiaries in Connecticut,” Jessica Pappas, UnitedHealthcare Medicare and Retirement, told Healio.com. “We know that these changes can be concerning for some doctors and customers, and supporting our customers is our highest priority. UnitedHealthcare will continue to stay focused on the people we serve.”

The ruling centered on evidence that UnitedHealthcare violated Medicare regulations by removing physicians without providing a reason or an explanation.

“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,” wrote Judge Stefan Underhill in the decision.

Connecticut Attorney General George Jepsen commended the associations for taking legal action and welcomed the decision.

“The decision confirms my view that these terminations — unprecedented in scope — offend public policy and threaten irreparable harm to patients whose relationships with their doctors are at risk of disruption,” Jepsen said in a statement.

Although the decision only affects the Connecticut physicians who filed suit, it could have national implications. Several states, including Ohio, New York and Florida, had been notified by the insurer that physicians would be dropped from the Medicare Advantage plan.

“We are aware of the court decision out of Connecticut,” Reginald Fields, director, communications and external affairs, Ohio State Medical Association, told Healio.com. “We are currently reviewing the ruling to determine how it might pertain to our situation here in Ohio and then we will decide what next steps we might take.”

UnitedHealthcare companies deliver products and services to approximately 70 million Americans, and its nationwide network includes 739,034 physicians and health care professionals, 80,000 dentists and 5,620 hospitals, according to the company’s website.