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State Officials Go To Bat For UnitedHealthcare Docs, Patients

by Hugh McQuaid | Dec 31, 2013 1:34pm
(7) Comments | Commenting has expired
Posted to: Health Care, Legal

State officials have filed “friend of the court” briefs in support of a lawsuit that would bar UnitedHealthcare from terminating contracts with doctors in its Medicare Advantage network.

The complaint was made by the Fairfield County Medical Association and the Hartford County Medical Association after UnitedHealthcare began dropping physicians from its Medicare Advantage network in October.

Earlier this month, a U.S. district court judge sided with the medical associations and issued an injunction against the insurance company, which has appealed the decision. Meanwhile, federal regulators — who reviewed the decision at the behest of Attorney General George Jepsen —concluded the company’s provider networks were adequate.

This week, Jepsen and state Healthcare Advocare Victoria Veltri filed a joint brief in support of the medical associations as the case moves to the Second Circuit of the U.S. Court of Appeals. In a separate brief, U.S. Sen. Richard Blumenthal, a former state attorney general, also backed the medical associations.

Jepsen and Veltri argued that the state has an interest in protecting elderly and vulnerable citizens from having their medical services disrupted. They called the terminated contracts an “unlawful” move that could impact as many as 10,000 Connecticut residents.

“The sheer size and scope of the physician terminations are, in the State Amici’s experience, unprecedented in Connecticut,” they wrote. “Though United has refused to disclose to Connecticut the exact number of physicians terminated or the number of enrollees affected, the District Court found that United has unilaterally, and without proper cause, terminated more than 2,000 physicians from its MAP.”

UnitedHealthcare spokeswoman Jessica Pappas said Tuesday that the company encourages its members to contact them with any questions about their doctor’s status or any other issues. She said they can call the number on the back of their membership card or by dialing 1-888-332-8883.

“The changes we are making to our network will encourage higher quality and more affordable Medicare coverage. Our focus is on supporting our members and helping them access the care they need,” Pappas said.

Hugh McQuaid Photo In his brief, Blumenthal included some specific examples of residents and doctors who have been impacted by the terminations. A doctor in Stafford Springs, who describes himself as the only full-time family medical practice in town, said United’s decision to drop him will create a “next to impossible situation” for many of his clients who will no longer have a provider in town.

Blumenthal said the appeals court should extend the lower court’s ruling to all doctors and stop the company from dropping doctors.

“I want to make sure that the court hears the voices of these patients,” Blumenthal said at a Monday press conference. “We give them life stories [in the brief] of people who are direly affected by this . . . abuse by UnitedHealthcare. It should not be abusing these elderly patients.”

The court is expected to hold a hearing on UnitedHealthcare’s appeal sometime in January.

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(7) Comments

posted by: DirtyJobsGUy | December 31, 2013  5:04pm

The story doesn’t note that the Medicare Advantage plans have gotten cut (in addition to physician compensation in other medicare areas) to fund Obamacare.  Since there is less money, the insurers have to cut costs by feeding larger numbers of patients to the physicians who will accept lower fees.  It’s easy for our low brow Senator Blumenthal to complain about insurance companies in the insurance state, but he says nothing about the root cause of this action.

Medicare is a timebomb just starting so explode yet none of our esteemed leaders will admit it.

posted by: Christine Stuart | December 31, 2013  5:15pm

Christine Stuart

More specifically, the problem is the five star rating system created under the ACA.

The allegation by the two medical societies in the federal lawsuit is that UnitedHealthcare is dropping doctors who serve some of its sicker patients. Those patients end up costing the insurance carrier more money and may make it more difficult for it to receive a five star rating under the Affordable Care Act. The higher the rating, the more money the carrier will receive in federal reimbursements.

Click here to re-read that story

posted by: StillRevolting | December 31, 2013  7:59pm

Camera-seeking Connecticut senator rails against the unintended consequences of his own party’s dreadful legislation. He makes no mention of the correlation while otherwise supporting that same dreadful legislation. That should about sum it up. Happy New Year!

posted by: middleoftheroad | December 31, 2013  8:43pm

The problem isn’t the ACA.  The problem is that the carriers want to continue to make profit at all costs.  The reason their rates were cut by the Feds is that they were making money by the boatload.  Those excess profits were used to fund Part D savings for patients among other items.  They are still making money on Medicare Advantage .  Because they aren’t making as much, they are cutting docs, which cuts utilization among higher cost visits, which in turn creates more profit.  It’s not rocket science.  It’s not the ACA. It’s about profits, pure and simple.

posted by: lkulmann | January 1, 2014  11:49am

This is an easy fix. If these patients are vulnerable and medically frail they should be treated with respect and fairness and placed on State Medicaid and these Doctors should sign on and accept Medicaid Assignment. Simple…think of it as a game of chess….CHECK!
Even easier…let the federal government administer the marketplace
https://www.healthcare.gov/‎
Too many hands in the CT cookie jar…The CT Regs still need to be updated and we have the ACA to implement…getting all these elderly and disabled out of nursing homes and home with supports…We’ve got plenty of work that needs to be done and jobs to create. Homes need to be adapted to accommodate these people. We need to beef up Home Care Services~ homemakers, CNA’s, Nursing, OT, PT, SLP,....adaptive equipment, ramps, motorized wheelchairs, elevators, jobs! jobs! jobs! Case workers Social Workers (new ones hopefully) Job Training and Coaches and ENTITLEMENTS and SERVICES!! This is a very exciting year and we have a lot to do….chop! chop! LET’s GO! We just can’t afford corrupt anymore… let go of the past and move on! Be a role model and teach these deadbeats that sucking the life out of the safety net system is undignified. Hard work and honest living and all that jazz that we’ve all read about in law school and political science!
Lets do it!

posted by: dano860 | January 2, 2014  10:28am

StillRevolting, he does continue to act as though he is still the pathetic A.G. that he was. You’re correct, the word in Hartford is that the most dangerous place to be is between Dicky and a camera. It is well known that he will appear at a garage door opening if the press and a camera are there.
The insurance companies are guaranteed a profit by law, it’s written into Owebamacare. They are dropping specialty hospitals and doctors due to their costs.
It’s real sad when they start dropping the local family doctor though.
It will be interesting to see the breakdown of people that have signed up for the federally funded insurance. All of the people that I have spoken to that have signed up are doing so under the ‘poverty’ provision. They can’t afford the better policies but are getting the subsidies and whatever plan they feel they might be able to swing.

posted by: lkulmann | January 2, 2014  10:17pm

Well at least New York Medical Society had enough class to higher a legal firm to represent their doctors. Our doctors in CT make the taxpayers foot the bill. The AG and The OHA…ugh! Does CT have an Insurance Department to assist or can the CT Medical Society higher a law firm? So this is why my 90 pound 19yr old disabled son is denied nutritional supplements? We have no money in the budget and we are paying DOCTORS legal fees with taxpayer money. We reimburse Medicaid doctors a few dollars for patient care but pay their legal fees. Priorities need adjusting here. The OHA represents the clients NOT the MD’s. The MD’s are representing the clients and their bread and butter. The Medical Society represent the MD’s. OK so why do we have an Insurance Department? I feel a flare up coming on…If I were OCD I would be on the floor in a fetal position sucking my thumb…rocking back and forth sweating~ trying to sort through this madness…