The Pulse
2:35 pm
Wed October 23, 2013

United And Medicare: When Insurers Drop Your Doctor

You may have heard about United Healthcare's decision to cut a number of doctors from its Medicare Advantage plan in Rhode Island and some surrounding states. That means that, for some seniors, their doctor may no longer be considered "in network" - and, therefore, no longer affordable for some, since "out of network" doctor visits cost more.

United is keeping tight-lipped about why it made this decision. It's not exactly clear why they did it or exactly how many doctors have been dropped, but it's likely because it's going to save them money. They haven't given any rationale to the doctors, to the Rhode Island Medical Society, or even to patients. There are about 36,000 United Medicare Advantage patients in Rhode Island.

Maybe United analysts ran an algorithm to find the most expensive patients, or doctors with the fewest number of patients. It wouldn't be difficult: United owns a company called OptumInsight, which offers several products that use such algorithms to find efficiencies. The company, when it was called Ingenix (but still owned by United), actually got in trouble for using such methods to lower reimbursement rates for out-of-network providers back in 2008, according to this article in the Pacific Standard (a nonprofit publication of the Miller-McCune Center for Research, Media and Public Policy).

Doctors, through the Rhode Island Medical Society, in particular, have sounded the alarm. They stand to lose some business themselves, after all, but I'm sure they're also concerned about their patients, who will have to pay out-of-network prices or find another doctor - which could be tough depending on what they're being seen for and where they live. RIMS spokesman Steven DeToy tells me they've called on state officials and Rhode Island's congressional delegation for help.

Here's what the RI Attorney General's office has to say about the situation, via an email from spokeswoman Amy Kempe:

"Attorney General Kilmartin is very concerned about this issue.  The Office has recently received several complaints from physicians about the Company’s plan to drop them from the network.  The Office has been in contact with both OHIC and DOH, who share the same concerns.  Because this is a federal program there is no legal regulatory jurisdiction for the Office, however we continue to closely monitor developments and study its potential impact on the access to, continuity and quality of care  for patients.  Attorney General Kilmartin reminds United that the Company should, at the very least, provide full disclosure to new customers of the Company’s plan to shrink the number of physicians in the network, giving consumers the chance to make a well-educated choice on which health insurer provides them with the best possible care."

If your doctor is being dropped, what can you do? It's not clear whether there's any recourse. But you should definitely talk with your doctor about your options, especially if you're in the middle of a treatment, for example.

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