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Boucher supports judge's United HealthCare decision

Published 2:19 pm, Monday, December 16, 2013
  • tate Sen. Toni Boucher, R-Wilton, joined the physicians from the Fairfield County and Hartford County medical associations in supporting the decision by a U.S. District Court judge to approve a temporary injunction keeping United HealthCare from dropping doctors. Photo: Contributed Photo, Contributed / New Canaan News Contributed
    tate Sen. Toni Boucher, R-Wilton, joined the physicians from the Fairfield County and Hartford County medical associations in supporting the decision by a U.S. District Court judge to approve a temporary injunction keeping United HealthCare from dropping doctors. Photo: Contributed Photo, Contributed

 

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State Sen. Toni Boucher, R-Wilton, joined the physicians from the Fairfield County and Hartford County medical associations in supporting the decision by a U.S. District Court judge to approve a temporary injunction keeping United HealthCare from dropping doctors.

"The changing health-care industry is putting our doctors and our residents in complicated and stressful situations," Boucher said. "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 judge ruled that the medical societies showed that the removal of doctors from the United Healthcare Medicare Advantage network could cause irreparable damage.

At a newsconference in Hartford Dec. 5, Boucher joined the physicians' associations in their efforts to fight the measures United Healthcare was taking with its Medicare Advantage Network.

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

The federal health-care 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 networks, effective Feb. 1.

Dr. Robin Oshman, president of the Fairfield County Medical Association, 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."

At a recent investor conference, United Healthcare parent United Health Group executives publicly stated they expect the Affordable Care Act'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 Dec. 7. 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 percent) 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.

Boucher will join the doctors in pursuing legislation in the next session to make network adequacy a local issue and require insurance companies provide more transparency to customers.

Boucher added, "The doctors made a strong argument for allowing any willing health-care 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."