Thousands of doctors in Connecticut are being dropped from UnitedHealthcare’s Medicare Advantage plans next year.
UnitedHealthcare spokesman Benjamin Goldstein confirmed the cuts although he said he did not have an exact number of doctors affected. However, the head of the Fairfield County Medical Association said Tuesday he was told that 2,250 physicians will be dropped from the plans.
Mark Thompson, the association’s executive director, said the change means untold numbers of patients will either face higher, out-of-network rates or be forced to choose a new doctor. The association estimated that the 2,250 represents about 19 percent of the insurer’s physician network in Connecticut.
UnitedHealthcare is one of a number of insurers that offer Medicare Advantage plans in Connecticut and across the nation. Medicare Advantage plans are a type of federal-government-funded health-care plan offered by private insurers to people age 65 and older. Insurers contract with the federal government to provide Medicare Parts A and B, which is hospital and medical coverage, respectively. A Medicare Advantage plan may also provide additional coverage, such as prescription drug benefits.
Thompson said he first learned of the change when his association got a complaint from a doctor last week. Thompson said that he phoned UnitedHealthcare and that someone there told him it plans to cut 810 primary care physicians and 1,440 medical specialists from its network.
The state Office of the Healthcare Advocate said it has received complaints about the change.
The federal government, through its Centers for Medicare & Medicaid Services, has instituted a five-star quality rating system that provides incentives to insurers to reduce costs, Thompson said, citing it as a contributing factor in the UnitedHealthcare change.
In an alert posted on its website, the Fairfield County Medical Association said:
“Claiming the information is proprietary, UHC would not share with the Fairfield County Medical Association the criteria the insurer used in deciding which physicians would be eliminated from the Medicare Advantage Plan provider panel. UHC acknowledged its decision whom to deselect was based on quality, physician panel size, and cost of the physician provider to the insurer among other items.”
In a phone interview Tuesday afternoon, Thompson said, “Obviously, our concern is, if United [Healthcare] feels like it has to do this, then are there other carriers thinking of doing the same thing to boost their profitability because they, too, want to get a higher star rating from the Centers for Medicare [& Medicaid] Services?”
The Centers for Medicare & Medicaid Services, which is affected by a shutdown of the federal government, did not comment on a request for information about the five-star quality rating system.
Asked about the reasons for the change, Goldstein, the UnitedHealthcare spokesman, said in an email: “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.”
The change does not affect UnitedHealthcare’s other health plans, only Medicare Advantage. UnitedHealthcare has about 58,000 people enrolled in Medicare Advantage plans in Connecticut and about 2.9 million nationwide. The company also has an affiliation with AARP, which allows UnitedHealthcare to brand its Medicare Advantage product with the AARP brand.
“We are notifying affected UnitedHealthcare members and are taking steps to help them transition to new providers,” Goldstein said in the email. “Members enrolled in our commercial, Medicaid and Medicare supplement plans are not impacted by current changes to the Medicare Advantage plan network in Connecticut. Our analysis of network changes is ongoing as we continue dialogue with local care providers.”
The Connecticut State Medical Society recently asked UnitedHealthcare to clarify that its networks are adequate.
“CSMS has been closely monitoring changes in United networks to evaluate the impact of reduced physician network participation,” Matthew C. Katz, CEO of the medical society, said in a prepared statement. “We caution against narrowing of networks or tiering, as those practices do nothing more than limit patient access to medically necessary care while increasing patient expense.”