One of the largest Medicare managed-care insurers in Ohio has been dropping doctors from plans that cover thousands of area seniors.
Marc Braun, 66, of Bath Township, is among those being forced to find a new doctor or switch insurers after recently being told UnitedHealthcare will no longer include his physician in its Medicare Advantage plans.
About 102,000 Ohio residents are enrolled in UnitedHealthcare’s Medicare managed-care plans.
The plans are optional for people covered by Medicare, the federal health insurance program for people ages 65 and older and some younger disabled Americans.
About 5,600 of the nearly 46,000 Summit County residents enrolled in Medicare Advantage plans are covered by UnitedHealthcare, some of which are marketed under the AARP name, according to the Centers for Medicare and Medicaid Services.
Other UnitedHealthcare plans aren’t impacted by the changes.
Braun recently was notified that his long-time family doctor and one of his specialists are being dropped by his UnitedHealthcare managed-care plan, effective Jan. 1.
His wife, Virginia, also would lose her primary-care doctor, along with two specialists, if she stays with UnitedHealthcare.
Most managed-care plans require enrollees to get care from an in-network doctor for services to be covered at the lowest cost to the consumer, or to be covered at all.
Braun received a letter from UnitedHealthcare listing another primary-care doctor that the insurer had selected for him. The letter didn’t indicate why his doctors were cut.
“We each got a letter saying that our doctors would no longer be in the plan and they are more than happy to help us find new doctors in their network — no explanation whatsoever,” Braun said. “We’re definitely shopping to switch plans. I think the way they handled it was very poor.”
Consumers can enroll in Medicare managed-care plans or change options during the annual open enrollment period, which started in October and continues through Dec. 7. Changes are effective Jan. 1.
At Fairlawn Family Practice, all four family physicians were dropped with no explanation, said Dr. Doug Lefton, a doctor in the practice and board member of the Summit County Medical Society.
About 100 patients in the practice are affected, he said.
The practice sent letters to all the affected patients letting them know the names of Medicare managed-care plans that continue to have the practice in their provider network.
Lefton said when they contacted UnitedHealthcare and appealed the decision, the doctors weren’t told why they were dropped.
“They never gave a clear answer as to why they’re doing this,” Lefton said. “It would be nice if they told us.”
UnitedHealthcare spokesman Kevin Shermach said “there are many factors involved” when determining which doctors to keep as network providers.
“Decisions about which doctors will remain part of our network can include the number of patients who are covered by our Medicare plans, the relative adequacy of our network in a particular market and the type of contract we have with an individual provider,” he said.
The cuts are part of the insurer’s strategy to reduce its provider network by about 10 to 15 percent nationwide by the end of 2014 as Medicare managed-care plans face reduced federal payments, Shermach said.
UnitedHealthcare hasn’t disclosed the exact number of doctors that are being dropped from the provider network for its Medicare managed-care plans.
The Medicare program gives managed-care companies money for each enrollee to cover the cost of their care. Some plans also charge enrollees a monthly premium.
“We will continue to offer members broad choice in access to care with one of the largest Medicare Advantage plan networks in Ohio in 2014,” Shermach said.
Less access to care?
But some doctors and physician groups are questioning whether dropping health-care providers will reduce access to care for consumers.
Several prominent dermatologists, neurosurgeons and other specialists that already are in high demand are among the area doctors dropped from the insurer’s Medicare Advantage local provider network, said Dr. Waleed W.F. Nemer, president of the Summit County Medical Society.
Nemer said the result could be longer waits for appointments.
“We haven’t seen … anything such as this,” he said. “Always, insurance companies have been in the mode of trying to recruit physicians, not drop physicians.”
The Ohio State Medical Society has heard from hundreds of doctors across the state who were dropped from the insurer’s Medicare managed-care network, said Todd Baker, the association’s director of professional relations.
The society plans to send a letter to the Centers for Medicare and Medicaid Services (CMS) asking for an investigation into whether UnitedHealthcare will have an appropriate provider network for enrollees, he said.
UnitedHealthcare has shared information for several months with CMS about its plans to change its provider network, according to a CMS spokesperson. The insurer met all requirements for notifying doctors and enrollees about the changes.
“CMS is monitoring the situation closely to ensure that United meets its regulatory requirements,” the spokesperson said.
Cheryl Powell can be reached at 330-996-3902 or email@example.com. Follow Powell on Twitter at twitter.com/abjcherylpowell.