United Health Care Terminations of Physicians in Medicare Advantage Plan

This is worrisome. Granted UHC may not be doing anything illegal, but are their actions ethical?
Disclaimer…at the local Area Office on Aging I assist folks with Medicare Advantage Plan comparisons. A very satisfying volunteer position. Well worth the 20 hours or so of training through the State of Ohio Department of Insurance.

From the 25 October 2013 blog item at the Medical Society of New Jersey

In mid-October UHC began terminating physicians in their Medicare Advantage plan. We immediately reached out to UHC when it appeared that the terminations were not isolated, but rather part of a   broad initiative. This week, UHC responded to some of our questions. We are disappointed that there was no warning of this termination initiative which appears to be a significant redesign of the UHC Medicare Advantage network, nationwide, and that information is sparse. For example, UHC would not tell us how many physicians in New Jersey were terminated or whether any specialties were immune to the termination initiative. Yet, UHC assured us that the network had been “tested and retested” for network adequacy and that there would not be a specialty access issue.

Network Adequacy: Obviously, MSNJ has no way of evaluating the impact on the network without more information. Therefore, we are asking all physicians who received termination letters, to provide us with information so that we can better evaluate network adequacy concerns. CMS has agreed to help us with that assessment.

Lack of Transparency: In addition to our network adequacy concerns, we are troubled that patients may be enrolling or re-enrolling in the UHC Medicare Advantage plan now, because seniors are in the middle of open enrollment, believing that they will be able to continue to be treated by physicians who are currently in the plan. UHC agreed to consider our complaint on lack of transparency on the 2014 network, given that seniors are enrolling now based on the current network. It is important to note that patients may change their network selection. CMS will honor the last selection made by the patient by December 7 when open enrollment ends.

Continuity of Care: We expressed our concerns about continuity of care and a disruption of established physician-patient relationships.  We urged UHC to carve out an exception for patients who wish to continue to see their current physician. UHC agreed to consider this request. We believe that patients should have the right to choose their physicians and must know their network status to make those choices.

Discussions with CMS: With a reopening of the federal government, we have contacted CMS about our network adequacy and continuity of care concerns. Our Region 2 office has been facilitating communication with the Region 9 office which is responsible for the UHC Medicare Advantage network. CMS Region 9 is charged with ensuring network adequacy and transparency for Medicare beneficiaries in their selection of a Medicare product. CMS has offered to test areas for network adequacy. Pleaseprovide us with information so that we can identify geographical and specialty areas of concern.

What to do: Last week we urged physicians who wished to stay in the Medicare Advantage network to appeal and provided suggestions for those appeals. We will continue to update our advice to members as more information becomes available to us.  Visit our web site for a list of Do’s and Don’ts, Appeal Suggestions, a template letter to inform patients of your imperiled status in the UHC Medicare Advantage Network.

Save the date for MSNJ’s UHC Termination Update webinar on Tuesday, October 29 at 7:00PM. Details to follow on www.msnj.org.

Related articles

• SICK: Seniors get notices of lost doctors… (nypost.com)
• Elderly Americans in a panic over losing doctors because of Obamacare (fellowshipoftheminds.com)
• UnitedHealthcare drops 10-15 percent of its doctors in Medicare advantage plans (nj.com)
• Connecticut Dems: Wait, Where’d Our Medicare Advantage Providers Go? (pjmedia.com)
• Whodathunkit? Elderly patients sick over losing doctors under ObamaCareElderly patients sick over losing doctors under ObamaCare (dancingczars.wordpress.com)
• United Healthcare dropping many doctors from Medicare Advantage plan (naplesnews.com)
• UnitedHealthcare Medicare Advantage practices in Florida raise eyebrows in Illinois. (preaprez.wordpress.com)
• Medicare insurer United Healthcare cuts doctor network (in Ohio) (Columbus Dispatch)
  

  “…

  aker said the State Medical Association plans to complain to the Centers for Medicare and Medicaid Services, which has contracts with all Medicare Advantage plans. He said the cuts will leave UnitedHealthcare with an inadequate provider network for Medicare enrollees.

  UnitedHealthcare’s parent, UnitedHealth Group, the largest provider of Medicare Advantage plans nationwide, signaled several months ago that it might shrink its business of managing care for seniors, according to Kaiser Health News. This month, UnitedHealth Group said funding cuts in Medicare Advantage plans had put a drag on its earnings.

  Shermach offered this prepared explanation for why the insurer is dropping doctors from its Ohio network: “With the many changes happening in the health-care industry, we are building a network of health-care providers that we can collaborate with more closely to have the most positive impact on the quality of care for our members. This will encourage better health outcomes and ultimately lower costs.

  “Additionally, more focused provider networks help deal with the financial pressures created by severe cutbacks in funding of Medicare Advantage and other government-sponsored programs.”

  The State Medical Association said UnitedHealthcare also has dropped doctors in other states, citing media reports in Florida and Connecticut.

  AARP Ohio spokeswoman Kathy Keller said the organization hasn’t heard concerns about the change from its members.

  Medicare Advantage plans are private insurance plans that cover hospital, medical and often prescription-drug expenses. About 36 percent of Ohio’s 2 million Medicare enrollees are in Medicare Advantage plans.”

[Not just for librarians!] Healthy Aging at Your Library: Connecting Older Adults to Health Information

My volunteer position at the NW Ohio Area Office on Aging brings me in contact with many older Americans with health issues.
The past few months I’ve been making follow up phone calls to screen folks for eligibility for the Extra Help Medicare Prescription Drug program **through the Social Security Office.   Quite a few screenings went beyond the rote answering of  about 15 questions related to income, resources and current prescription drug coverage. At times I got quite an earful of their present medical conditions, financial conditions, and inability to fully take care of themselves and others.  Was usually able to refer folks to in-house and area resources.

This morning I came across a training class for librarians on how to assist older Americans on how to locate health information.
While information doesn’t cure or assist on it’s own, it does empower people.  At the Area Office on Aging, we do not advise, but present information so they can make their own best possible decisions.

The class material is online and free. I’ll be going through the materials on my own. Partly so I can be a better volunteer.
Also, I’ll be adding some of the material to my Google site, Health Resources for All.

Some interesting factoids from the online class, Healthy Aging at Your Library, specifically the Power Point presentation

• The number of Americans aged 65 years or older during the next 25 years will double to about 72 million.
•  By 2030, older adults will account for roughly 20% of the U.S. population.
• 2 out of 3 older Americans have multiple chronic conditions, and treatment for this population accounts for 66% of the country’s health care budget ***

• Heart Disease – #1 cause of death adults over age 65
• Cancer – #2 cause of death adults over age 65
• Patients with low literacy skills were observed to have a 50% increased risk of hospitalization
• Only 3% of older adults surveyed had proficient health literacy skills

Related articles

• Medicare Part D Notice (bwjames.wordpress.com)
• Be ready for shift in Medicare programs (TBO.com)
• Medicare plans underreport risky RXs for seniors (futurity.org)
• Medicare Donut Hole: How to Make the Best of It (health.usnews.com)
• Medicare and the Marketplace: 4 Things You Need to Know (aarp.org)
• Should your doctor consult the librarian? (futurity.org)

**Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia.

To see if you qualify, and apply… do one of the following

• Go to  the Extra Help screening tool/application page
• Call the US Social Security Office 1-800-772-1213 (somtimes one can bypass menu options by saying “Customer Service”_
• Contact your nearest Area Office on Aging, United Way, or similar agency

*** Right now at the Area Office, I am doing Medicare Advantage Plans and Part D (Prescription Drug) plan comparisons. Part of the comparison includes entering all prescription drugs used. This can get quite lengthy. Averages around 8 drugs, the record for me was 27 prescription drugs entered for one person.

I encourage folks to compare Medicare Advantage Plans/Part D plans every year. Even if one is happy with one’s plan, it does not hurt to look at others.
Medicare.gov (the official government site) has a tool where one can compare plans for free. The results are in an easy to read chart, which includes prices, coverage, co-pays, and more.

Need assistance in doing the online comparisons? Contact your local Area Office on Aging, United Way, or other related social service agency.

[Reblog] Rising Medicare Part D Drug Premiums & How to Compare Plans

From the 10 October 2013 article at As Our Parents Age

 

Check out this interactive plan finder.

Take a few minutes to read As Medicare Drug Premiums Soar It’s Time to Shop Around, another informative article about prescription drug plan open season.

[Flahiff’s note…
If you do not have ready access to a computer or find computers challenging, try these resources for assistance in comparing plans

• Local Area Office on Aging (may have a slightly different name in your area)
  As a volunteer at our area office, this is our top priority during open enrollment…which ends December 7th
• Local United Way for referral to agencies in your area (211 for most localities)
• Local public library for referral to agencies in your area (ask for a  reference librarian)]

This October 2, 2012 Reuters article by Mark Miller goes into considerable detail about the rising premiums and explains what steps Medicare beneficiaries can take to shop around.

Best Quote from the Article: Premiums for many popular Medicare prescription drug plans will soar next year – but seniors don’t have to take the rate hikes lying down.

It goes hand-in-hand with the other article I reviewed in my September 30, 2012 blog post, Medicare Prescription Drug Plan: 2013 Info.

Medicare beneficiaries and their adult children can use these two articles, together with the Plan Finder at Medicare.gov. At the top right on  the page is a button that takes visitors to an online demonstration of the Plan Finder.

Related articles

• Evaluating Medicare plans (miamiherald.com)
• Q&A: Medicare open enrollment too often overlooked (mcclatchydc.com)
• Report: Premium hikes for top Medicare drug plans (cnsnews.com)
• By the Numbers: Medicare Costs for Seniors to Rise Under President’s Plan (heritage.org)
• Report: Premium hikes for top Medicare drug plans (kansascity.com)
• Time for a Medicare switcheroo? (bankrate.com)
• Do you know Medicare Plans and what is best for you? (getlifebenefits.wordpress.com)
• Medicare Part D and Medicare Advantage Changes for 2013 (extendhealth.wordpress.com)
• Medicare Part C, Medicare Part C Coverage, Medicare Part C Enrollment and resources to help consumers understand… (getlifebenefits.wordpress.com)
• So What Does Medicare Cover? (kcet.org)