Health Care
5:00 pm
Mon November 25, 2013

United's Medicare Move: More Limited Choice Ahead?

RIPR health care reporter Kristin Gourlay joined host Dave Fallon in the studio to talk about what United Healthcare's recent decision to drop several hundred doctors from its Medicare Advantage plan means for the 36,0000 or so Rhode Islanders in that plan. Following is a transcript of their conversation, and a link to listen.

United Healthcare is dropping hundreds of doctors in Rhode Island
United Healthcare is dropping hundreds of doctors in Rhode Island

DAVE: 36, 000 Rhode Island seniors enrolled in a United Healthcare Medicare plan may receive a letter from their United plan telling them their doctor may no longer be covered. Rhode Island Public Radio health care reporter Kristin Gourlay joins us now in the studio to talk about what’s going on, and what it means for these Medicare members and their doctors. Hello Kristin.

KRISTIN: Hi Dave.

DAVE: So, Kristin, we’ve learned that United Healthcare is dropping several hundred doctors – no one knows for sure how many exactly – from its Medicare Advantage plan. If that’s the kind of health insurance you have – United’s Medicare advantage plan – what does that mean for you?

KRISTIN: It means that your plan no longer covers that doctor’s services, in a nutshell. So, if you want to keep seeing that particular doctor, you’ll either have to pay for it all yourself, or switch to a Medicare plan that includes that doctor in its network. So, if you stick with United’s Medicare Advantage plan, you’ll have fewer choices when it comes to doctors – maybe you’ll have to travel farther to see an eye surgeon or a heart surgeon, for example.

DAVE: What about emergencies?

KRISTIN: United told me in a statement that if it’s an emergency, it’s covered just like it would be in the network. And you have the option of petitioning United to keep seeing a particular doctor if you’re in treatment for something or can’t find a new doctor within a reasonable distance. But, if you’re concerned about this, the good news is that this is the “open enrollment” period for Medicare. That means you have until December 7 to change plans. And there are other options in Rhode Island that may include your doctor. If you have a question about what or who is covered, you should definitely call your insurer or check with your doctor.

DAVE: So, less choice for patients. And for doctors, of course, this means they could be losing some business. I hear we don’t have a list of doctors United has dropped, but do we know what kind of doctors are no longer in their network?

KRISTIN: The Rhode Island Medical Society is trying to stay on top of this. They tell me that it’s all kinds of doctors. Pretty much every surgeon at Rhode Island Hospital. Every open heart surgeon in the state. And some other specialists, like rheumatologists and podiatrists.  They estimate around 500 doctors are being notified by United that they’re no longer in this particular network.

DAVE: It sounds like a lot of disruption for patients and doctors. How’s the transition being managed? Have patients been notified?

KRISTIN: That’s what’s been frustrating for a lot of doctors and patients. The Rhode Island Medical Society has been hearing from its members that they only received word about the changes in October. And they’ve just started hearing from patients getting letters about this in the mail. But United Healthcare has remained tight-lipped about its reasons and about how it’s communicating with its members. And some state leaders, like health department head Dr. Michael Fine, say they’re concerned with the way this all came out – that there hasn’t been enough information or enough time to deal with these changes.

DAVE: Kristin, has United Healthcare explained why they’ve decided to drop these doctors from their Medicare Advantage plan?

KRISTIN: Not really. They emailed us a statement that basically said that they’re trying to focus their Medicare advantage network on higher quality, more affordable health coverage. They pointed to government funding cuts to Medicare, rising health care costs and rising quality standards they have to meet as some of the reasons behind these changes. But we haven’t been able to get an answer from them about why these particular doctors, or how they arrived at their decision. There are some theories. And they all boil down to: United is trying to cut costs.

UnitedHealth group, the parent company, is publicly traded, they’ve got shareholders to answer to. Some of the most recent financial analysts’ reports on United say the company is going to have to continue to look for ways to control costs in the coming years. Medicare is a big part of its business, and the federal government is looking to cut Medicare payments over the next several years.

DAVE: What is it about this move that’s attracted so much attention? Haven’t we seen insurance companies reduce benefits or limit networks before?

KRISTIN: I think the Rhode Island Medical Society’s spokesman Steven Detoy explained it best. Here’s what he told us:

“What make this one different is that it is being reduced in mid-stream, if you will. Generally what has happened in the past, and we’re fully expecting it to happen in the future, is that an insurance company will say, ‘alright, we’re going to market a plan that has limited networks.’ And they go around and sign up doctors to be in the limited networks, and then the patients or the employers sign up to be part of that limited network. In this case, United’s saying, after the product’s out there and after they’ve got 36,000 people signed up for it, that, ‘We’re going to change.’”

KRISTIN: First, keep in mind that they are allowed to do this – and the state has no say because Medicare is a federally regulated program. And there’s a general trend in health care toward more limited networks of doctors and other providers, and a bit less choice overall. That’s because one of the reasons we’ve gotten ourselves into this mess of super high health care costs in this country is that, for people who have health insurance, we’ve been able to pick and choose basically whatever health care we want or need whenever we need it. Choice is expensive. And we may have to start getting used to a bit less of it if we want to keep costs down.

DAVE: Thank you, Kristin.

KRISTIN: A pleasure, Dave.