Court Tells United Healthcare to Reinstate Physicians

December 11, 2013

HARTFORD, CT — Physicians' groups in two Connecticut counties have prevailed, at least temporarily, against plans by United Healthcare (UHC) to drop thousands of providers from the company's Medicare Advantage network[1,2].

Last month, the Fairfield County Medical Association and Hartford County Medical Association filed in federal court for an injunction against UHC's termination of 2250 physicians from the network. Last week, US District Court Judge Stefan R Underhill granted a temporary injunction, stating his view that the plaintiffs' breach-of-contract allegations would likely be upheld by the courts.

In its coverage of the story, the Hartford Courant notes that Hartford and Fairfield counties account for 59% of physician members of the Connecticut State Medical Society[3].

In October, UHC had informed thousands of providers and their patients that they were being cut from its Medicare Advantage programs, the Medicare Part C coverage option administered by insurance companies, as reported by heartwire . UHC also markets the plans through AARP, which calls them AARP MedicareComplete.

United Healthcare has maintained from the beginning of the saga that its physician contracts allow to it to drop whomever it wants from the program, that it would appeal the court's decision, and that would it proceed with the terminations in Connecticut outside Hartford and Fairfield counties. "How it all plays out is likely to be watched closely by other states, including Ohio, New York, and Florida, where the insurer also has notified physicians they would be dropped," wrote Courant reporters Matthew Sturdevant and Brian Dowling on December 6[3].

Indeed, physician groups in some other states have already weighed in. "This is very good news from Connecticut," Dr Sam L Unterricht, president of the Medical Society of the State of New York, states in an article in Kaiser Health News[4]. "We will definitely seriously consider filing a suit in New York as well."

The story, by Susan Jaffe, goes on to quote Todd Baker, spokesperson for the Ohio State Medical Association, who said his organization "is also reviewing the decision."

The preliminary injunction, her December 6 story continued, "comes less than 48 hours before a deadline at midnight tomorrow for seniors to choose a Medicare Advantage or drug plan for next year. Medicare officials said they don't plan to extend the deadline for beneficiaries affected by the terminations but will continue to monitor the situation."

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