United Healthcare Dropping Some Medicare Providers

Practices in Winston-Salem, Greensboro, Raleigh and Fayetteville that are in-network with United Healthcare (UHC) Medicare Advantage plans may receive a disheartening letter from the insurance giant in the coming weeks. UHC Medicare Solutions has begun dropping participating physicians in North Carolina as they have in 10 other states. The official notices state that the practice’s Medicare Advantage contract with UHC will be terminated without cause.

UHC has not disclosed how many physicians will be affected, but in a recent meeting they told North Carolina Medical Society (NCMS) CEO Robert Seligson the number of physicians being dropped in North Carolina will be “more modest” than elsewhere in the country.

Last fall in Connecticut, UHC was preparing to terminate about 2,250 physicians when two county medical societies in the state were successful in convincing a U.S. District Court to issue an injunction to stop the cancelations.  UHC appealed to the 2nd US Circuit Court of Appeals in New York. At that point NCMS along with 32 other national, state, county and specialty medical associations joined as friends of the court supporting the injunction in Connecticut and opposing UHC’s efforts to move ahead with such terminations elsewhere in the country. Read the amicus brief (PDF).

The Court of Appeals modified the injunction giving doctors up to 30 days to challenge their removal from UHC’s network through arbitration.  Doctors in Connecticut who did not arbitrate their termination are no longer in the network. Those who did proceed to arbitration caused such a backlog of cases at the American Association of Arbitration, UHC agreed to extend the arbitration deadline.

The NCMS encourages doctors who receive termination notices from UHC to consider appealing their terminations. UHC also told NCMS  if a physician believes they have special circumstances, for instance they are the only one in the network to provide a specific service, UHC would consider an appeal of the termination.

NCMS will continue to monitor the situation and seek any opportunity to help our members.

 
 

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1 Comment

  • Why NOT those terminated and others at risk for future termination JUST drop out and see those patients as an out of network or ask those patients to change insurers.
    Why we as physicians don’t have “BALLS” to Quit those insurance companies before they terminate US. Just don’t sign up for any underpaying (less than 140% of Medicare rate)insurers at all, Tell them GET LOST, If you have courage and balls to stand up to them.