Health Plans to Docs: Curb Costs or We'll Kick You Out

Kenneth J. Terry, MA

Disclosures

May 09, 2014

In This Article

Doctors Getting Dropped From Medicare Advantage

United has not only terminated doctors in Connecticut, but has also informed physicians in 10 other states of its intention to drop them from its Medicare Advantage plans.[1] Humana, Anthem Blue Cross Blue Shield, and some other Blues plans are reportedly following suit, and Aetna is said to be considering it.[2] A spokesperson for the American Medical Association (AMA) says that there have been "large-scale terminations" of doctors in Medicare Advantage plans in Arkansas, California, Connecticut, Florida, Indiana, Missouri, Nebraska, New Jersey, New York, Ohio, Rhode Island, and Texas. (Personal communication: Robert J. Mills, AMA spokesman; April 22, 2014.)

When United announced it was shedding roughly 20% of its Medicare Advantage network in Connecticut last November, the Fairfield and Hartford County medical societies rallied their doctors and filed suit against the action, claiming it violated United's contracts with the physicians. A federal judge in Bridgeport, Connecticut, agreed and issued a temporary restraining order.[3]

An appeals court in February upheld the district court's decision that United had no right to terminate doctors without cause in the middle of a contract period. It gave the doctors who were dropped the opportunity to seek legal arbitration of their dispute with the plan within 30 days.Those who did not seek arbitration by March 10 would be out of United's network.[4]

One terminated physician who chose not to do so is physiatrist Michael Saffir, MD, of Fairfield, Connecticut. Saffir, who is also President of the Connecticut State Medical Society (CSMS), told Medscape that his group has not sought arbitration because it would have been expensive and the contract will be up for renewal in a few months, anyway.

Even if United offers a new contract to him and the other doctors it dropped, Saffir says, he believes it will be one "that puts them at great risk to be terminated." So, while he can't predict what will happen, the physicians' future with United doesn't appear to be bright.

A UnitedHealthcare spokesperson declined to answer questions from Medscape.

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