UnitedHealth Cutting More Docs From Medicare Advantage
New cuts seen in at least five states and affecting up to 10 percent of physicians
FRIDAY, June 27, 2014 (HealthDay News) -- UnitedHealth Group's Medicare Advantage network has begun notifying physicians of a new wave of cuts to its network, according to an article published June 17 in Medical Economics.
The author of the article, Rachael Zimlich, notes that Medicare Advantage, an alternative to fee-for-service plans, provides coverage through private insurers for 30 percent of Americans on Medicare. State medical associations in states including Alabama, Georgia, Massachusetts, North Carolina, and Tennessee report the recent termination announcements, which range from two to four percent of physicians in the network in Massachusetts to a 10 percent reduction in Georgia. State medical associations and national professional organizations say the terminations are "without cause" and have asked the Centers for Medicare & Medicaid Services (CMS) to take action.
According to Zimlich, while UnitedHealth reports efforts to ensure members having to change physicians will not have their ongoing care disrupted, others are concerned. U.S. Representative Rosa DeLauro (D-Conn.) announced in the spring that she would introduce the Medicare Advantage Participant Bill of Rights Act to prohibit plans from dropping physicians in the middle of the year. Additionally, DeLauro has asked the Government Accountability Office to launch an investigation into CMS' oversight of UnitedHealth's actions.
"Among the many factors that we consider are the relative breadth of our network in a particular market, the access and health care needs of our local membership, the number of UnitedHealthcare members seen by a provider, as well as the type of contract we have with that doctor," UnitedHealth spokesman Terence O'Hara said in an e-mailed statement to Medical Economics.