A month ago, all five physicians in our practice received notice that we would no longer be covered under UnitedHealthcare Medicare Advantage plans. No reason was given, nor had we been given any kind of advanced notice that this was even a possibility. This was based on our business tax ID number, by the way, not on any individual doctor’s credentials. Very quickly it became evident that this was part of a 20%-30% reduction in their physician panels in multiple states, including Rhode Island, Connecticut, New York, New Jersey, Florida, Indiana, and Ohio.
What hasn’t been so easy to figure out is why. The insurance giant has not been forthcoming about the decision. In an advertisement in the Providence Journal, they cited "severe funding reductions for Medicare Advantage Plans."
Medicare Advantage Plans are Medicare plans that are administered by private insurance companies. They contract with the government to administer Medicare, and patients also pay a premium, making it profitable for insurers. These plans, however, are more expensive for the federal government, and in an effort to curtail the burgeoning cost of health care, "companies that don’t use 80% to 85% of revenues on care are forced to issue rebates to members for the difference," according to financial services company The Motley Fool.
In addition, there have been proposed rate cuts to Medicare Advantage Plans, in part to offset the cost of expanding Medicaid as the Affordable Care Act mandates. The Associated Press reported that UnitedHealthcare stock did not perform as expected in the third quarter of 2013. UnitedHealthcare blamed this on the rate cuts that the federal government imposed on Medicare.
So perhaps the Medicare Advantage Plans are not as profitable for the company as they once were, as the aforementioned advertisement in the Providence Journal implied. That does not explain the reduction of 20%-30% of their providers, though.
In a statement to the Hartford Courant, Dennis O’Brien, regional president of UnitedHealthcare Networks, had this to say: "We are assessing our network in Connecticut to help us provide higher quality and more affordable health care coverage for Medicare beneficiaries."
That explains nothing at all. It implies that the physicians they removed from their roster were of inferior quality and were costing them more money. And yet they have not given any explanation for what these "higher quality and more affordable" standards are. Furthermore, if quality and cost were the real issue, why would we be appropriate for UnitedHealthcare commercial patients but not for Medicare patients?
There has been a lot of speculation about why UnitedHealthcare is doing this, but until the company is more forthcoming, or is forced to account for its behavior (by subscribers or by politicians), we won’t really know.
In the meantime, the company’s unilateral decision will leave thousands of patients across states with interrupted medical care. It will take time for these patients to find new doctors, establish care, and build rapport.
If there is anything that’s become clearer to me from this debacle, it is this: We doctors hold ourselves accountable to our patients, but UnitedHealthcare, and maybe other private insurers as well, is accountable only to its shareholders.
In the debate over universal health care, health care is repeatedly referred to as a commodity that is malleable according to market forces. But this is a false equivalence, is it not? Chief Justice John Roberts’ preference for broccoli may be subject to supply and demand, but your right to health care should not be. That narrative needs to be reframed if people’s health and well-being are ever to trump the investors’ bottom line.
Dr. Chan practices rheumatology in Pawtucket, R.I.