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

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Presentation on theme: "Challenging UnitedHealthcare: The Connecticut Experience Michael F. Saffir, MD President Connecticut State Medical Society."— Presentation transcript:

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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