Attorney General George Jepsen is frustrated with the response he’s gotten from UnitedHealthcare, so he’s asking federal regulators to “aggressively scrutinize” the insurance company’s decision to drop doctors from its network.
The insurance company began dropping physicians from its Medicare Advantage network in October, but it refuses to say how many physicians and patients may be impacted by its decision to shrink its network.
Jepsen doesn’t have the power to compel the health insurance carrier to come forward with the information about its network or to extend the Medicare enrollment period beyond Dec. 7, so he’s calling on the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services to get involved.
“As you know, my office lacks the authority to resolve these important issues regarding a federally administered program,” Jepsen wrote federal regulators Wednesday. “Consequently, I urge your agency to aggressively scrutinize this large and potentially harmful provider termination initiative.”
According to correspondence released by Jepsen’s office, his special counsel wrote to UnitedHealthcare on Oct. 16 and asked it to provide more information about the actual number of doctors who had been sent termination notices.
“Although we have made some changes to our Medicare Advantage network in Connecticut for 2014, UnitedHealthcare will continue to offer a high quality network of physicians, specialists, and other providers to our Medicare Advantage beneficiaries,” Bryan Carroll, UnitedHealthcare’s associate general counsel responded on Oct. 24. “This includes nearly 3,000 primary care physicians and more than 4,400 specialists in Connecticut who will participate in our Medicare Advantage network in 2014.”
Jepsen said the company is clearly refusing to answer the most basic questions.
“United has resisted providing this office with even the most basic information about the scope of its termination and its impact upon patients —namely, the number of doctors terminated from its network and the number of patients who, as a result of those terminations, will be forced to seek care with other doctors within United’s network or pursue different benefit options during open enrollment,” Jepsen wrote Wednesday to the regional director. “We are deeply troubled by [how] United insisted that its remaining provider network will be adequate despite simultaneously claiming not to know the number of patients affected.”
UnitedHealthcare doesn’t believe it’s being an obstructionist.
“We have worked with and will continue to work with the Centers for Medicare & Medicaid Services and others, including the Connecticut Attorney General’s office, to help address the needs of local providers and members and further explain the changes we are making to our Medicare Advantage network,” Maria Gordon Shydlo, UnitedHealthcare’s public relations director, said in an email.
She said the company understands that the changes, “while necessary, will be disruptive for some members.” She encouraged anyone with questions to call 888-332-8883.
Dr. Steven Wolfson, vice chair of the council for the Connecticut State Medical Society, said they met with officials from UnitedHealthcare and UnitedHealth Group, its parent company, last week and tried to ascertain the impact the terminations will have on doctors and their patients.
“As we look at the impact of the termination on patient care we really feel it will be jeopardized,” Wolfson said. “In short, it looks as though they took a very blunt instrument to the health care delivery system that may cause a lot of injury to patients.”
He said the group of physicians was told that none of the doctors were terminated for cause, which makes it very hard for them to appeal the decision.
UnitedHealthcare won’t confirm which physicians it has terminated, but sources say it sent letters to every member of the Yale Medical School’s faculty.
Earlier in the day, the Fairfield County Medical Association and the Hartford County Medical Association filed a federal lawsuit against UnitedHealthcare and UnitedHealth Group in an attempt to stop the terminations from going forward.
“Although no reason was provided for this unilateral termination, United’s motives are nonetheless clear: By terminating numerous physicians from the MA Networks, United seeks to stem financial losses occasioned by reduced federal payments under the Affordable Care Act,” the lawsuit claims.
The complaint goes on to say that United has repeatedly said it wants to improve its doctor networks, but “what United instead is doing is shifting the financial burdens imposed by the Affordable Care Act from itself, a multi-billion dollar company, to the providers and patients, all with the aim of maximizing revenues. Such a bad faith response, which undermines clear legislative policies and is being done solely for the sake of profits, cannot be condoned.”
