UHC Medicare Advantage Physician Terminations-Organized Medicine Urges that Recent Terminations be Held in Abeyance

MSNJ continues to send appeal letters to CMS and request that it test network adequacy on a case-by-case basis. Please continue to provide information to MSNJ.

MSNJ met with representatives from UHC this week at our offices in Lawrenceville. One of our continuing concerns is how UHC will communicate with its Medicare Advantage members concerning its network reduction initiative and whether Medicare patients will know if their physician will be in the network in 2014. UHC responded that:

Members with recent claims for physicians leaving the network will receive a letter from UHC at least 30 days before the effective date of the termination with instructions to call the customer service number for more information. UHC currently estimates member mailings to take place in early November. Timelines are not yet final for member mailing dates, and are subject to change as data analysis is completed and information finalized.

Consequently, the timing of UHC communication with patients may be as late as the end of the year according to the above information. We are disappointed  because the open enrollment period will have ended and it will be too late for patients to make choices based on the physicians who will remain in these plans. To address this ongoing transparency concern, and the ability of Medicare patients to make informed choices to keep their physician if they wish to, MSNJ joined with the AMA and virtually all of organized medicine requesting that CMS require Medicare Advantage plans to hold all terminations initiated just prior to or during Open Enrollment in abeyance for cost year 2014. Read the letter to CMS which asks that it extend the Medicare Advantage open enrollment period and require plans that have reduced their networks to:

1)     Provide and document that patients received actual and accurate notice of whether their current physicians will be in the 2014 network;

2)     Ensure that patients know that they can retain their physician by choosing fee for service or by choosing a product with an out-of-network benefit if their plan provides one.

3)     Provide physicians information needed to challenge network adequacy based on CMS regulations and extend the appeals deadline until physicians receive such information;

4)     Provide information on how many patients have been impacted and which physicians to state medical societies and the AMA; and,

5)     Direct plans to hold all terminations initiated just prior to or during Open Enrollment in abeyance for cost year 2014.

In addition to our disappointment about UHC’s plans for the timing and communication with patients, UHC also advised this week that it would not carve out an exception for patients who wish to continue to be treated by physicians who may be terminated. UHC will provide us with its continuity of care policy.

UHC advised that physicians should contact their provider representatives to discuss staying in the network. We have posted an updated provider representative list on our web site for members who wish to do so. Since we cannot anticipate how successful these conversations may be, we recommend that physicians appeal from network terminations and supplement pending appeal letters with new information. Visit MSNJ’s web site for appeal pointers. Members should visit the web site for additional resources. We continue to send appeal letters to CMS and ask that it test network adequacy on a case-by-case basis. Please continue to provide information to MSNJ.

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About MSNJ

Founded in 1766, the Medical Society of New Jersey is the oldest professional society in the United States. The organization and its dues-paying members are dedicated to a healthy New Jersey, working to ensure the sanctity of the physician–patient relationship. In representing all medical disciplines, MSNJ advocates for the rights of patients and physicians alike, for the delivery of the highest quality medical care. This allows response to the patients’ individual, varied needs, in an ethical and compassionate environment, in order to create a healthy Garden State and healthy citizens.

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