Judge stops UnitedHealthcare from terminating Medicare docs

By BenefitsPro

By Dan Berman

A decision stopping UnitedHealthcare from terminating more than 2,000 doctors from its Medicare Advantage plan in Connecticut is under scrutiny by medical groups across the country. U.S. District Court Stefan Underhill issued a restraining order after the medical associations of Fairfield and Hartford counties sought emergency relief.

The restraining order came two days before a deadline for the 14 million seniors enrolled in Medicare Advantage policies to choose a doctor for the coming year. About 2.9 million of those use UnitedHealthcare for the insurance, which provides more drug coverage than traditional Medicare, but requires patients to use network doctors.

The associations and UnitedHealthcare disagree, the court said, about whether the insurer could drop doctors without notice. The court ruled that the medical groups were likely to win their lawsuit based on contractual claims.

In his order, Underhill wrote, “United’s argument that it has a unilateral right to terminate participating physicians from participation in the Medicare Advantage plan by amendment of that plan is not supported by the language of the contract or the parties' experience under it.”

The company, which is dropping doctors from Medicare Advantage plans in several states, said it is appealing the ruling. The reasons for dropping the doctors are unclear, but some reports say a major factor is that some physicians refuse to accept lower reimbursement for services.

News reports said state medical associations in Ohio and New York are watching to see the outcome. The president of the New York group, Sam Unterricht, was quoted by Kaiser Health News as saying the association was considering a similar suit. A spokesman for the Ohio group was quoted as saying it was looking at the judge’s ruling.

Earlier this month, UnitedHealthcare said it expected to absorb a cut in Medicare Advantage payments from the government.

Last month, America’s Health Insurance Plans warned in a letter to the head of the Centers for Medicare and Medicaid Services Administration that cuts included in the Patient Protection and Affordable Care Act were already causing coverage reductions and price increases.

Originally published on BenefitsPro.com