UnitedHealthcare is headed to federal court-ordered arbitration with two doctors groups in Connecticut over the insurer's decision to drop some physicians from its Medicare Advantage network.
A federal appeals court has ordered UnitedHealthcare, the Fairfield County Medical Association, and the Hartford County Medical Association to try to settle their differences over UnitedHealth's decision to drop 2,200 physicians from its Medicare Advantage (MA) network.
The three-judge panel of the 2nd Circuit Court of Appeals issued the order on Tuesday after hearing oral arguments from both sides. The medical associations filed suit in federal court against UnitedHealth claiming the insurer is violating federal law by dropping the physicians without cause and without the ability to appeal United's decision.
"We want the reasons why they are letting doctors go only for MA plans and not other plans," says Mark Thompson, executive director of the Fairfield County Medical Association, one of two plaintiffs. "We want doctors to have opportunity to arbitrate."
See Also: Will Physicians Be Dropped From Managed Care Networks?
A judge issued a temporary restraining order against UnitedHealth in December, ordering it to halt the cuts. The hearing on Tuesday, expedited by the court, was in response to an appeal by UnitedHealth. The three-judge panel left the injunction against UnitedHealth in place, but ordered all parties to the court's Civil Appeals Management Plan, known as CAMP.
"We are pleased that the court recognized the importance of our appeal by expediting its review of the preliminary injunction," said Jessica Pappas, spokeswoman for UnitedHealth.
CAMP is a mediation process in the 2nd Circuit overseen by a court-appointed attorney and typically used before the court hears arguments. It's "unusual" that the court ordered the two sides to CAMP after oral arguments, but this week's hearing was expedited and mediation wasn't realistic, says attorney Roy Breitenbach, who is representing both the Fairfield & Hartford county medical associations.
"Mediation begins next week," says Breitenbach. "CAMP usually lasts about a day. The court-appointed attorney will then decide if it's worth having another session."
If there isn't room for agreement and a settlement seems unlikely, then the two sides will have to wait for the court's ruling, which Breitenbach estimates could be "one or two months."
The court's decisions may have an impact beyond Connecticut. The matter is being watched closely in New York, where the Medical Society of the State of New York has filed suit against the insurer for the same issue—dropping MA providers.
A Narrowing of Networks
UnitedHealth is narrowing its network of providers to deal with the 6.5% MA reimbursement rate reduction last year (and another cut expected this year) that helps pay for the Patient Protection and Affordable Care Act.
"The changes that we and other Medicare Advantage plans are making will bring better health outcomes and more affordable health care coverage to Medicare Advantage members," says Pappas.
"While these changes can be difficult for patients and their doctors, they are necessary to meet rising quality standards, slow the increase in health costs and sustain our plans in an era of Medicare Advantage funding cuts. Our focus remains on supporting our members and helping them access the care they need."
The providers are upset because they claim UnitedHealth's action limits patients' access to care. Beneficiaries are confused over why their longtime doctors are no longer part of their plan.
The issue has drawn in the American Medical Association and America's Health Insurance Plans. The AMA signed a brief in support of Connecticut's move to avert provider reductions, and AHIP sent a letter to the Centers for Medicare & Medicaid Services in November asking the federal agency to resist preventing insurers from cutting some providers loose.
"We are concerned that efforts are underway to encourage CMS to limit efforts by MA plans to establish more focused, high-performance networks …." wrote Karen Ignani, President and CEO of AHIP.
The physicians in Connecticut bolstered their case on Wednesday, the day after the federal appeals court listened to arguments, at a Senate Special Committee on Aging field hearing, which also took place in Connecticut, on the very issue of how Medicare Advantage changes affect consumers.
The committee heard from AHIP officials, a Medicare beneficiary, and Michael Saffir, MD, president of the Connecticut State Medical Society and a practicing physician who UnitedHealth cut from its MA network.
According to Saffir's testimony, "…United[Health] patients have received letters saying that they can switch to another doctor for their care, but when patients call this doctor's office, they are told that they can't be seen, or that they will have to wait weeks or even months for an appointment."
One of Saffir's patients, Richard Johnson, a retiree from Bridgeport, echoed Saffir's concerns, telling the committee he didn't understand why he couldn't see Saffir, who gave him "excellent care" for three years.
Because of the pending court case, UnitedHealth can't technically cut ties with Saffir just yet, but that message hasn't been made clear to beneficiaries like Johnson, who just wants to keep seeing his doctor.
"When you have health problems, you want to stay with the doctors who knows you personally and takes excellent care of you," said Johnson.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.