Physicians gather to fight UnitedHealthcare’s Medicare network cancellations

The Hartford County and Fairfield County medical associations in Connecticut took their fight against UnitedHealthcare to a town hall meeting November 26, in front of prominent federal and state legislators, as well as doctors from across the state. UnitedHealthcare has removed more than 2,200 physicians from its Medicare Advantage program in the state.

The two medical associations have taken UnitedHealthcare to federal court in Bridgeport, Connecticut, with a hearing scheduled for Dec. 3 before U.S. District Judge Stefan Underhill. They are seeking a temporary restraining order preventing the health insurer from removing the physicians-about 20 percent of the UnitedHealthcare provider panel-from its Medicare Advantage networks. Anywhere from 20,000 to 30,000 patients could be affected, the medical associations claim.

Bollepalli Subbarao, MD, president of the Hartford County Medical Association, said his group is confident the judge will grant the restraining order but concedes the ruling might go against the group because contract language does permit the cancellation. One tactic that might work is a class action suit by the patients. “We need to think about other options,” he said.

During the meeting, Michael P. Connair, MD, an orthopedist from North Haven, Conn., called on his medical colleagues-not acting in collusion-to quit working for UnitedHealthcare. “The individual actions of many doctors can bring an insurance company to its knees and threaten its economic vitality,” he told the audience of 63, which included legislators, doctors, patients and association staff, at the West Hartford Meeting and Convention Center.

Connair, who is a member of the National Union of Hospital and Health Care Employees, as well as the Federation of Physicians and Dentists, cited actions physicians took in Ohio and Rhode Island when insurers sought to cut reimbursement rates. The physician departure from the insurance companies left them without enough doctors to provide adequate coverage in their networks. "UnitedHealthcare crumbles pretty quickly if they don't have the services for their patients," he said.

U.S. Sen. Richard Blumenthal (D-CT) said the entire Connecticut Congressional delegation has been conferring with the Centers for Medicare and Medicaid Services (CMS) to push the federal agency to determine the adequacy of UnitedHealthcare's network in the wake of so many doctors being cut. "We're determined to use every bit of persuasion available to us," he said, slamming UnitedHealthcare for not being responsive to legislative calls for information on its decision, which he said was done "simply to fatten the bottom line of UnitedHealthcare."
As previously reported by Medical Economics, thousands of physicians in Arkansas, Florida, Indiana, Nebraska, New Jersey, New York, Ohio, Rhode Island, Texas, and Utah are believed to have been impacted by recent network cancellations by health insurance companies. The American Medical Association (AMA) adds that cancellations have also been reported by physicians from Anthem, Blue Cross and Blue Shield plans, and Humana. The AMA, with 81 other medical groups, including the American College of Physicians and American Osteopathic Association, said the terminations were “without cause” and called on Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services (CMS) to address the “lack of Medicare Advantage sponsor transparency on network adequacy.”

At yesterday’s meeting, Blumenthal told Medical Economics in a brief interview, "My hope is [CMS] will be responsive. If they're not, I'm not sure what the next step will be. I won't discuss our options beyond that. We're not in the business of making threats but we will consider the alternatives," he said.

UnitedHealthcare did not return a telephone call for comment. Bryan Carroll, UnitedHealthcare’s associate general counsel, did confirm its Medicare Advantage network in Connecticut includes 3,000 primary care physicians and 4,400 specialists in correspondence with the state of Connecticut’s Attorney General George Jepsen.

UnitedHealthcare’s Carroll says in written correspondence that there are many factors involved with the decision. “All of them relate to providing a network of physicians who we can collaborate with to help enhance health plan quality, improve healthcare outcomes, and curb the growth in healthcare costs. Decisions about which doctors will remain part of our network can include the number of patients who are covered by our plans, the relative adequacy of our network in a particular market, and the type of contract we have with the doctor.”

At yesterday’s meeting, Laureen Rubino, MD, a general surgeon from Manchester, Connecticut, warned of dire times ahead if doctors don't win this fight against UnitedHealthcare. "This is going to affect us with all insurance companies if we don't take a stand," she said. "It will spread to other insurance companies if we don't stop this."

Rubino called on physicians to vet payer contracts with insurers and attorneys.
"Whoever thought they could cut you out of the entire program?" she said, a point driven home when a UnitedHealthcare representative told her office manager the move was taken because it was allowed in her contract.

In her practice, Rubino said, 35 patients are affected her practice’s network cancellation. "It's difficult because there's no criteria. I don't have malpractice. I don't have any issues. I do the third most robotic surgeries in Connecticut. The way they did it, I can't take care of my patients any more."