Congressional Delegation Wants Answers From UnitedHealthcare After Cuts To Doctor Network

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The Connecticut congressional delegation has stepped up pressure on UnitedHealth Group to answer questions regarding the company’s decision to drop thousands of doctors from its Medicare Advantage program next year — a decision made public only a week before the enrollment period for 2014 began Oct. 15.

A letter dated Wednesday, and made public Thursday, was addressed to UnitedHealthcare Medicare & Retirement CEO Jack Larsen and signed by all five congressmen and both U.S. senators from Connecticut. Individual members of the delegation have expressed concern in recent weeks, but this is the first action they have taken together on the cuts.

“We would like to better understand the process of notification by [UnitedHealth Group] that was made to your Connecticut participants and physicians in compliance with [Centers for Medicare and Medicaid Services] requirements for notice,” the letter said.

UnitedHealth Group of Minnetonka, Minn., is the parent company of UnitedHealthcare, the insurer that has about 58,000 Medicare Advantage customers this year in Connecticut. Changes to the doctor network would take effect Feb. 1 next year for people who enroll this fall during the open enrollment period from Oct. 15 through Dec. 7.

“We also need a better understanding of how network adequacy requirements will be met despite the sudden drop of what appears to be nearly one quarter of [UnitedHealth Group’s Medicare Advantage] provider network. This significant reduction in physicians raises many concerns about whether people who have chosen to participate in the [UnitedHealth Group] program will have adequate time to make informed decisions about their Medicare coverage before the open Medicare enrollment period closes on December 7.”

They ask for a response by Oct. 31.

Specifically, they want to know:

—    Exactly how many providers will be dropped, where they are located, and their specialties.

—    Details of the providers who will remain in the network.

—    The number of days’ notice plan holders had before the end of the enrollment period.

—    How the company decided who to cut.

—    Exemptions granted that would allow plan holders to continue to use providers otherwise cut from the network.

UnitedHealthcare spokeswoman Jessica Pappas said in a prepared statement Thursday: “Ultimately the network for our Medicare plans has to be more focused around the needs of our members. The changes we are making will encourage higher quality health care coverage and help keep that coverage affordable for them, which is all the more urgent because of the underfunding of Medicare Advantage.”

Pappas added that the company understands the changes are disruptive to members affected by them and, “we are prepared to support members in transitioning to a new doctor. We are in the process of notifying members affected by these changes by mail.”

The delegation’s letter follows a conference call that the delegation set up with UnitedHealthcare to address concerns raised by doctors and constituents, said U.S. Rep. Joe Courtney, D-2nd District.

“The feedback we got was obviously not sufficient, otherwise I don’t think we would have sent the letter,” Courtney said of UnitedHealthcare.

The insurer offered to get a “rolling list” of doctors to the delegation to clarify who is in and who is out, Courtney said. But people want to know if their doctor is in or out of network before signing up for a plan, Courtney said.

Additionally, Courtney said the UnitedHealthcare representative who spoke to the delegation was not aware of the CHOICES program, which stands for Connecticut’s program for Health insurance assistance, Outreach, Information and referral, Counseling, Eligibility Screening. It’s a resource for the elderly who have questions as they sign up for Medicare Advantage plans, and Courtney said UnitedHealthcare needs to notify CHOICES immediately about exact changes to the physician network.

“There really wasn’t much localized help that we received, and, thus, the letter,” Courtney said. He has also written to Marilyn Tavenner, administrator for the federal Centers for Medicare and Medicaid Services. A regional director has told Courtney’s office that they are looking into the matter, though the agency is still ramping up after a partial federal shutdown that left CMS with very few workers.

UnitedHealthcare’s decision to reduce its network became public earlier this month, and it sent doctors and patients scrambling to find out how they might be affected.

UnitedHealthcare has released limited information about the decision.

The head of the Fairfield County Medical Association, which has been critical of the decision, has said the insurer plans to eliminate 810 primary-care physicians and 1,440 specialists next year.

UnitedHealthcare will not say exactly how many doctors it will have in its network next year. Earlier this month, the company said it will have “more than 1,500” primary care physicians. However, the number increased the following week to “nearly 3,000” in an Oct. 16 full-page advertisement open letter signed by Larsen, UnitedHealth CEO.

The company has also said it has “more than 4,000” specialists while Larsen wrote in his letter that it is “more than 4,400.”

Pappas, the company spokeswoman, said in a prepared statement, “We have worked with and will continue to work with the Centers for Medicare & Medicaid Services and others, including the Connecticut Congressional delegation, to help address the needs of local providers and members and further explain the reasons behind the changes we are making to our Medicare Advantage network.”

Medicare Advantage is a type of health plan funded by the federal government that is available to people 65 and older. It is administered by private insurers and covers Medicare Parts A and B benefits, which is hospital and medical coverage. Additionally, insurers court customers by offering other benefits, such as out-of-pocket cost protection, vision, hearing or dental coverage — none of which is available through traditional fee-for-service Medicare coverage offered by the government.

About Matthew Sturdevant

Full-time staff journalist at The Hartford Courant and magazine freelancer with a master's degree in writing from Dartmouth. My work has appeared in The Los Angeles Times, The Chicago Tribune, Taiwan News, The Baltimore Sun and many other news sources. My blog has been referenced by Politico.com, the Kaiser Family Foundation, the Georgetown Law Library and a number of organizations in healthcare and business. Sturdevant’s blog is "a well-written wealth of ideas," said The Donald W. Reynolds National Center for Business Journalism, (businessjournalism.org, May 18, 2011). I have experience writing for newspapers, magazines, Web sites and blogs as well as shooting and editing video. I made regular appearances on news-talk radio and on the NBC affiliate station in Corpus Christi, Texas. I made occasional appearances on the Fox affiliate in Connecticut promoting Hartford Courant articles.

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