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Challenging UnitedHealthcare: The Connecticut Experience

Challenging UnitedHealthcare: The Connecticut Experience. Michael F. Saffir, MD President Connecticut State Medical Society . October 2013 . UHC’s abrupt termination of 1000s of CT physicians took everyone by surprise No warning from UHC Some had renewed as recently as July/August

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Challenging UnitedHealthcare: The Connecticut Experience

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  1. Challenging UnitedHealthcare:The Connecticut Experience Michael F. Saffir, MD President Connecticut State Medical Society

  2. October 2013 UHC’s abrupt termination of 1000s of CT physicians took everyone by surprise • No warning from UHC • Some had renewed as recently as July/August • No reason for terminations • Tough to appeal if you don’t know why you were dropped • No patient communication • Even though Medicare Open Enrollment period was about to start

  3. CSMS Actions • Alerted Governor, CT Attorney General, CT Healthcare Advocate • Critical to keep state officials in the loop, even though Medicare is federally regulated • Reached out to the CT Congressional delegation • Both Senators, all 5 Reps wrote to UHC CEO: detailed list of questions about the network terminations • Delegation members also held a call with UHC CEO • Rep. Joe Courtney (CT-2) sent a separate letter to CMS Administrator Marilyn Tavenner

  4. CSMS Actions • Contacted the AMA’s Litigation Center, worked with them to develop a letter to CMS Administrator Tavenner • AMA letter co-signed by 39 state medical societies, 42 national specialty societies • Contacted officials at the Centers for Medicare and Medicaid Services (CMS), as well as the regional office of the Department of Health and Human Services (HHS)

  5. CSMS Actions • Continually pressed UHC for more information, successfully brought UHC national executives to the table for a face-to-face meeting – the first state medical society in the nation to do so • Kept members informed throughout the process • Developed downloadable material for physicians, including Talking with Patients About United MA Cuts and Appealing United MA Network Cuts: Guidance for Physicians • Regular updates via CSMS website, Weekly E-News

  6. Legal Actions • 2 Connecticut county medical societies, Fairfield and Hartford, brought a lawsuit against UHC. • FCMA, HCMA are CSMS component medical associations • A temporary injunction was issued against UHC in district court in CT • UHC appealed the decision to the Second Circuit Court of Appeals

  7. Legal Actions • CSMS supported the lawsuit, filing two amici briefs in support of the action in the Second Circuit Court of Appeals. • On appeal, the Second Circuit Court of Appeals allowed the injunction to continue for a limited time in order to allow impacted physicians to file for arbitration. • The temporary injunction expired on 3/9/14.

  8. January 2014:Senate Hearing • Sen. Richard Blumenthal organized a field hearing for the Senate Special Committee on Aging in Hartford, CT • Sen. Blumenthal was joined by fellow Committee member Sen. Sheldon Whitehouse (RI) and CT Sen. Chris Murphy • CSMS was invited to present public testimony at the hearing, and also to speak at the Senators’ press conference beforehand

  9. April 2014: Congressional Support Rep. Rosa DeLauro (CT-3) announced her sponsorship of a Medicare Advantage Participant Bill of Rights Act. Still being drafted; tentative bill provisions include: • Bans mid-year provider terminations without cause • Requires MA Plans to fix networks in advance of Open Enrollment • Requires MA Plans to provide adequate notice to patients and maintain continuity of care

  10. April 2014:Yale-New Haven Hospital United’s pattern of behavior continues – ignoring physicians and their patients in favor of the bottom line • Effective 4/1/14, Yale New Haven Hospital was removed from United’s Medicare Advantage network • Physicians notified just 6 weeks in advance • Physicians told they would be dropped if they did not have privileges at any other United MA network hospital, effective 7/1/14 

  11. April 2014:Yale-New Haven Hospital • Patients were not notified of the changes until late May – leaving many frail, elderly patients scrambling yet again to find a physician to care for them • Other UHC network hospitals may be difficult to access (some as far as 30 minutes away by car, nearly an hour by bus) • United says the YNHH change is minimal, affecting “only” 30 or 40 physicians • Yet cuts come less than 6 months after thousands of physicians were initially cut from the UHC network

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