Federal Judge Rules in Favor of Doctors, Boucher Standing with Doctors & Patients

Press Release from State Senator Toni Boucher

Senator Toni Boucher (R-Wilton) joined Physicians from both the Fairfield County Medical Association and the Hartford County Medical Association supporting the decision by a U.S. District judge to approve a temporary injunction keeping United HealthCare from dropping doctors.

“The changing healthcare industry is putting our doctors and our residents in complicated and stressful situations,” said Sen. Boucher.  “Allowing all parties more time to figure this out can only benefit everyone involved.  These are people’s lives that are hanging in the balance.”

The federal Judge ruled the medical societies showed that the removal of doctors from the United Healthcare Medicare Advantage network could cause irreparable damage.

At a press conference in Hartford, Thursday, Sen. Boucher joined the physicians associations in their efforts to fight the drastic measures United Healthcare was taking with its Medicare Advantage Network (MA).

“Many of the constituents I am hearing from are elderly and are left wondering what they will do if they lose their physicians,” added Boucher.

The federal healthcare law requires cuts to the Medicare Advantage program to help pay for other parts of health care reform. Facing reduced reimbursement payments, insurers are severely trimming provider networks to keep their Medicare Advantage businesses profitable.

In October, numerous physicians (more than 2,000 throughout Connecticut) in the Fairfield County area received notice from United Healthcare that they would no longer be a provider in the Medicare Advantage (MA) networks, effective February 1, 2014.

Dr. Robin Oshman-President, Fairfield County Medical Association (FCMA) said, "We still don't know if doctors are in or out.  The entire Yale medical group has been dropped from the plan. Dialysis patients are being told to go to Long Island. They can't do that; they are too sick."

Dr. Bollepalli "Bo" Subbarao, president of the Hartford County Medical Association, said “they [United HealthCare] have betrayed the trust of the public.”

At a recent investor conference, United Healthcare parent United Health Group executives publicly stated they expect Obamacare's fees, rate cuts and reforms to cost the health insurer as much as $1.9 billion next year.

The issue is further complicated by the fact that open enrollment for Medicare Advantage ends in December and there are concerns that patients may not know which physicians will be available to them when they sign up.

After receiving letters in October, patients were forced to find another physician or plan by December 7, 2013. Senator Boucher sent a letter last month to Connecticut’s Insurance Commissioner Thomas Leonardi expressing concern for constituents. United HealthCare has approximately 58,000 patients in Connecticut. 

In part, Boucher’s letter stated, “…Many {patients} have received conflicting information as to whether their doctor will still be participating in the network. For regular patients and especially those with serious medical conditions, this is a distressing and even frightening occurrence that has made it all but impossible for seniors to organize their health coverage as the Medicare open enrollment period begins.”

Medicare Advantage is an alternative to traditional Medicare that is provided by for a private insurer. Medicare Advantage plans are required to cover all of the same benefits as Medicaid (except hospice) and in many cases provide additional benefits such as prescription drug coverage and out of pocket maximum limits.

According to the Kaiser Foundation in 2012, of the 586,545 Medicare enrollees in Connecticut, 123,694 individuals (21%) were enrolled in Medicare Advantage plans. The Medical Societies are advising patients to tell United HealthCare that they are required to honor the Continuity of Care clause in their contracts.  This will allow patients to stay with their physician until end of next year.

Federal law requires that Medicare Advantage networks meet certain network adequacy standards. Regulations in part require that, “MA applicants must demonstrate that 90 percent of beneficiaries (or more) have access to at least one provider/facility, for each specialty type, within established time and distance requirements.” 

Meantime, a lawsuit brought by physicians groups challenging whether, by contract, the insurer has the right to eliminate thousands of doctors on Feb. 1, has reverberated not just in Connecticut but throughout the country as the changes in the Affordable Care Act take effect. The consequences of this change to the Medicare Advantage plan negatively affect the elderly and sick patients that the process was designed to help. 

Some cancer patients with only months to live will need to quickly find alternatives. These alternatives can be very far from where the patient resides. It is also unclear how other doctors will be able to absorb the estimate 30,000 patients who have now lost their physicians, when many have already closed their practices to new patients.

Senator Boucher will join the Doctors in pursuing legislation this next legislative session to do the following:

•  Make Network Adequacy a local issue

•  Require Insurance companies provide more transparency to customers

Senator Boucher added, “The doctors made a strong argument for allowing any willing healthcare provider to be included in any plan if the a doctor was willing to accept whatever terms the insurance company negotiates with regard to terms and fees, thereby keeping the doctor-patient relationship intact. We need to take a stand for our constituents.”

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State Senator Toni Boucher’s letter to Connecticut Insurance Cmsr. Leonardi:

November 22, 2013

Thomas B. Leonardi, Commissioner
Department of Insurance
153 Market Street
Hartford, CT 06103

Dear Commissioner Leonardi,

UnitedHealth Group recently announced that it would be dropping doctors from its Medicare Advantage network. Unfortunately, the company has not yet disclosed how many doctors have been affected by this decision. 

As you can imagine, this announcement has caused mass confusion among both physicians and patients, many of whom have received conflicting information as to whether their doctor will still be participating in the network. For regular patients and especially those with serious medical conditions, this is a distressing and even frightening occurrence that has made it all but impossible for seniors to organize their health coverage as the Medicare open enrollment period 

begins. My office has heard from numerous constituents who have been unable to obtain reliable information from any source and who have been left in doubt about the status of their coverage.

I hope that the Insurance Department will be able to offer some guidance on this issue until more information becomes available. I would be grateful for your feedback as to what assistance is available to patients affected by this disruption and whether the Insurance Department can intercede in any way on their behalf.

Thank you for your attention to this important matter.

Sincerely,
Toni Boucher
State Senator