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Judge Rules In Favor of Keeping Docs In Network

by Christine Stuart | Dec 6, 2013 11:11am
(4) Comments | Commenting has expired

Christine Stuart file photo

Dr. Robin Oshman

A federal judge ruled in favor Thursday of the Fairfield County Medical Association and the Hartford County Medical Association when he ordered UnitedHealthcare to stop terminating contracts with doctors in its Medicare Advantage network.

U.S. District Court Judge Stefan Underhill granted the temporary injunction against the insurance carrier after finding the two medical associations demonstrated “that they will suffer harm that is imminent and cannot be adequately compensated through damages.”

He said the reputation of the doctor and the physician-patient relationship would be jeopardized if UnitedHealthcare proceeds with these termination notices. The termination notices, according to court documents, went out to approximately 2,200 doctors in Connecticut shortly after open enrollment in the program began.

The two medical associations asked the court for an injunction on Nov. 6 after they were unable to get answers about how many doctors were terminated and how many patients would be impacted. They held a press conference Thursday in Hartford to bring more attention to damage being done to physician-patient relationships as they waited for Underhill’s decision.

“We still don’t know if doctors are in or out,” Dr. Robin Oshman, president of the Fairfield County Medical Association, said Thursday. “The entire Yale medical group has been dropped from the plan. Dialysis patients are being told to go to Long Island. They can’t do that; they are too sick.”

Cardiologists in Norwalk and Norwich, oncologists in Bridgeport, and the entire Yale Medical Group was removed from UnitedHealthcare’s Medicare Advantage plan, Oshman said.

She said a patient who has six months to live called the medical association in tears because she was told she will have to find a new oncology doctor.

“Several district and circuit courts have found that disruption of the physician-patient relationship can cause irreparable harm that justifies issuing preliminary injunctive relief, particularly when the patient belongs to a vulnerable class or may have a deep trust relationship with the physician because of the serious nature of the patient’s illness or medical needs,” Underhill wrote.

Underhill wrote that while UnitedHealthcare argued it was terminating the physicians without cause based on their contract, the company failed to “provide written notice of the ‘reasons for the action, including, if relevant, the standards and profiling data used to evaluate the physician and the number and mix of physicians needed by the MA organization’.”

“That did not occur here, in apparent breach of both Medicare regulations and the Physician Contract provisions regarding termination,” Underhill wrote.

During oral arguments earlier this week, Underhill said that UnitedHealthcare suggested that it routinely amends its contract without the consent of the participating physician in order to remove physicians from a particular plan. He went on to say that the evidence the insurance carrier provided to him as proof does not support its assertion.

“Although United apparently has added Connecticut physicians to a plan by amendment . . . it has not terminated Connecticut physicians in that way.” He concluded that the medical associations were “likely to prevail on their breach of contract claims.”

A spokeswoman for UnitedHealthcare said the company intends to appeal the ruling.

“We believe the court’s ruling will create unnecessary and harmful confusion and disruption to Medicare beneficiaries in Connecticut,” Jessica Pappas, a spokeswoman for UnitedHealthcare, said. “We continue to have a broad network of doctors that is designed to encourage higher quality, affordable health care coverage. 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.”

Dr. Bollepalli Subbarao, president of the Hartford County Medical Association, called the ruling a “victory” for both doctors and patients.

“This indicates we are on the right track,” Subbarao said Friday. “We are the right advocates for our patients and our members as well. We know medicine.”

He said UnitedHealthcare tried to ” terminate us by essentially trying to strong arm us into thinking we don’t know what’s going on.” He said he’s glad the judge applied the law appropriately.

Attorney General George Jepsen, who asked federal regulators to step in and stop UnitedHealthcare from moving forward with the terminations, praised Underhill’s decision.

“This 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 Friday.

He urged the insurance carrier not to seek an appeal.

“I urge United to abide by the court’s decision and its clear contractual obligations to all affected physicians, not just those who are members of the Fairfield and Hartford County Medical Associations. Its failure to do so will only compound the confusion United has already caused to thousands of vulnerable Connecticut patients and prospective Medicare Advantage enrollees, who deserve much greater care and respect.”

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(4) Comments

posted by: Matt W. | December 6, 2013  12:06pm

Matt W.

I guess “without cause” wasn’t clear enough.

posted by: LongJohn47 | December 6, 2013  4:51pm

Is it any wonder that people hate insurance companies?

posted by: edvolpintestamd | December 6, 2013  8:43pm

December 6, 2013
Connecticut NewsJunkie.com

Re “Judge rules in favor of keeping docs in network” in Dec. 6 issue:
Physicians not only in Connecticut but across the nation should be thankful that the leaders of the Fairfield County and Hartford County Medical Associations have challenged the arrogance of UnitedHealthcare. 
I am hopeful that the courage shown in Connecticut will spread to state medical societies everywhere.  UHC by its reckless and callous action may have done physicians a great favor by igniting their anger and moving them unite and once and for all to convince lawmakers to limit the power that private insurers exert on the practice of medicine.
Edward Volpintesta MD

posted by: sofaman | December 10, 2013  11:37pm

. . . and wise observers will continue to ask: what exactly are insurance companies adding to the health care system?. . .