UnitedHealthcare, Doctors Fight In Federal Court Over Physician Network Cuts

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BRIDGEPORT — With the enrollment deadline for 2014 Medicare plans only days away, a federal judge is about to rule on a temporary injunction that would keep UnitedHealthcare from cutting its Medicare Advantage network by an estimated 2,200 doctors.

A decision awaits affidavits requested by the judge, who could rule as soon as Wednesday. The enrollment deadline is Saturday.

Meanwhile, some of UnitedHealthcare’s estimated 58,000 customers in Connecticut are left wondering if their doctors will be in or out of network. If they’re out, customers would have to pay much more to be treated by them.

A legal battle flared Tuesday in U.S. District Court between the health insurer and both the Fairfield County Medical Association and the Hartford County Medical Association. Their lawyers debated whether, by contract, the insurer has the right to eliminate thousands of doctors on Feb. 1.

The insurer has never said exactly how many doctors would be dropped. The Fairfield County Medical Association has estimated the number to be 2,200.

One Medicare Advantage customer, Lawrence Thompson, 77, of Newtown, was so concerned that he showed up in court to watch the proceedings. At one point, he stood up and received permission from Judge Stefan R. Underhill to speak.

Thompson said he and his wife both learned that their ophthalmologist, Dr. Betty Klein of Danbury, will be out of network next year. He said Klein treated his macular degeneration and continues to treat his wife’s glaucoma with several treatments that would be interrupted if they had to switch ophthalmologists to keep paying less expensive in-network rates. He is also looking at other plans that have Klein in the network.

Thompson said he hopes the judge will issue a temporary injunction so he can keep the UnitedHealthcare plan. “If we went to a new doctor, what would that do?” he said.

At the heart of the legal debate is whether the insurer has the right to amend its contract with doctors and drop clinicians on Feb. 1, 2014.

Roy W. Breitenbach, a lawyer for the two doctor associations, said UnitedHealthcare’s change to the physician network violated the contract, which he said can only be terminated on the anniversary date of the contractual agreement, which is a different date for each doctor.

“We’re strictly looking to vindicate contract rights,” Breitenbach told the judge.

The Fairfield County Medical Association and the Hartford County Medical Association teamed up in suing UnitedHealthcare after the insurer sent out letters, beginning in October, informing doctors they would be dropped from its Medicare Advantage network as of Feb. 1. The doctors would remain in-network for other UnitedHealthcare plans, such as commercial insurance offered by employers that used UnitedHealthcare as their insurer.

One of UnitedHealthcare’s several attorneys in the case, William H. Jordan, said UnitedHealthcare cut its network with permission from the U.S. Centers for Medicare & Medicaid Services. Judge Underhill took issue with that assessment, saying that federal Medicare officials appeared only to be approving the 90 days’ notice that UnitedHealthcare gave to doctors — not the substance of the letter.

Jordan replied, “I think it’s much more than the ministerial or procedural issue.”

Lawyers for the doctor associations want a temporary injunction to keep the doctors in-network until the matter is resolved in court.

UnitedHealthcare argued that there are a number of reasons why the insurer should not reverse the network cuts, including federal procedural issues, Jordan said, though he did not specify what the issues are. He also said that customers have already been told of the cuts and that the new networks have been publicized online, and to change them now would confuse people.

Underhill responded, “These are problems that United has brought upon itself … the source of the confusion is the seemingly incorrect interpretation of the contract.”

The court went into recess without a decision about the temporary injunction. Underhill asked attorneys for UnitedHealthcare to provide an affidavit showing a previous unilateral termination of doctors without cause and without consent, to illustrate what has been done in the past. He also asked the medical associations for an affidavit that would illustrate how previous terminations have been handled.

Medicare is federal government-funded health insurance primarily for people 65 and older. Medicare Advantage is a version of Medicare Parts A and B, hospital and medical coverage, administered by private insurers.

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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