New legislation submitted by two Connecticut members of Congress would require health insurers to finalize their physician networks for Medicare Advantage plans 60 days before the autumn enrollment begins.
The goal of the Medicare Advantage Participant Bill of Rights Act is to keep patients from having changes to their doctor networks mid year, forcing them to either pay higher, out-of-network rates or switch physicians.
The bill, introduced Thursday, requires insurers that offer Medicare Advantage to disclose the reasons for ending contracts with medical providers. It also requires the federal Centers for Medicare and Medicaid Services to redesign the online tool
U.S. Rep. Rosa DeLauro, D-3rd District, introduced the legislation in the U.S. House and a companion bill was introduced in the Senate by U.S. Sen. Sherrod Brown, D-Ohio, and U.S. Rep. Richard Blumenthal, D-Conn.
Last fall, UnitedHealthcare told an unspecified number of doctors they would be dropped from the insurer’s Medicare Advantage network in early 2014. The Fairfield County Medical Association said the change reduced UnitedHealthcare’s Connecticut network by 810 primary care physicians and 1,440 medical specialists.
Additionally, about 30 doctors in the New Haven area will be out of UnitedHealthcare’s Medicare Advantage network starting July 1. UnitedHealthcare and Yale-New Haven Hospital failed to agree on terms for treating the insurer’s Medicare Advantage patients. The hospital has been out of network for those patients since April 1.
Blumenthal said UnitedHealthcare’s actions have huge consequences for “our most elderly and frail seniors.”
“The point is to provide certain standards that are specific and enforceable so as to leave no doubt that there is protection against this very arbitrary and self interested step by insurers,” Blumenthal said Thursday.
Brendan Buck, a spokesman for the trade group America’s Health Insurance Plans, said companies that provide Medicare Advantage plans are committed to ensuring stable, affordable coverage for the 16 million beneficiaries who rely on the program.
“There are already strong consumer protections in place including extensive network adequacy standards, and Medicare Advantage remains extremely popular with American seniors,” Buck said in a statement.
DeLauro said in a statement: “The timing and scale of UnitedHealth Group’s provider cuts have been extremely disruptive to their Connecticut patients and put them at risk. We have a responsibility to ensure that Medicare Advantage plans are serving the needs of their participants.”
UnitedHealthcare spokeswoman Jessica Pappas said Thursday, “We continue to offer Medicare Advantage enrollees a broad choice of primary care physicians and specialists in Connecticut and elsewhere, and are committed to ensuring Medicare beneficiaries have access to quality, affordable care.”