The Pulse
1:06 pm
Tue December 10, 2013

CT Docs Vs. United Healthcare: Will RI Docs Follow Suit?

Connecticut doctors sued United Healthcare for dropping them from their Medicare Advantage network. Will Rhode Island follow suit?

Probably not, says Steven DeToy with the Rhode Island Medical Society. He told me he thinks it's unlikely the doctors will have any luck in court because United had the right to drop doctors - it's in their contract. And if they did, it could get expensive and messy: doctors could be responsible for half the cost of mediation if it comes to that.

The federal judge in Connecticut had a problem with the mechanism United used to drop doctors, and United has appealed. Detoy told me he'd spoken with lawyers involved in the case and they expect a ruling on the appeal by the end of this week. This means there's probably not much doctors can do to reverse United's decision.

But how do United's Medicare Advantage members felt about it? Whether enough of them voting with their feet could persuade United to reinstate these doctors isn't clear. The Medicare enrollment deadline just passed.

What is clear is that members, doctors, and insurers seem stuck between a rock and a hard place: Congress wants insurers to rein in Medicare costs; doctors are battling uncertain Medicare reimbursements; and patients are facing less choice (in some cases). What might help are efforts to promote more preventative care and to pay doctors and networks of doctors for keeping patients healthy, rather than on a fee-for-service basis.

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