Doctor cuts surprise thousands of Ohioans


About 5,000 Ohioans were unaware that their doctors had been dropped from their Medicare Advantage plan on Jan. 1, according to their insurer, United Healthcare, which attributed the oversight to a database error.

The company said it would move “as quickly as possible” to notify its members and would continue to honor claims from the approximately 660 affected physicians and their patients for at least the next two months.

“We deeply regret any confusion this error has caused for our members and their physicians,” said Kevin Shermach, a United Healthcare spokesman. “We have taken action to support these members, including extending in-network benefits with affected providers through March 31, 2014.”

The company said it would reassign affected policyholders to a new primary care physicians in its Medicare Advantage network this year.

Shermach said the notification oversight was limited to Ohio, where the health insurer serves about 102,000 individual Medicare members.

United Healthcare’s decision to drop hundreds of physicians from its Medicare Advantage plan came under fire from the Ohio State Medical Association late last year.

The health insurer said it was narrowing its provider network in response to cuts in reimbursements to Medicare Advantage called for under the Patient Protection and Affordable Care Act.

But the medical association complained the cuts were too deep and asked the Centers for Medicare and Medicaid Services to investigate whether United Healthcare’s move to trim its provider network would compromise coverage for seniors in Ohio.

As a result, the medical association said at least 10 practices with more than 75 doctors have been reinstated to United Healthcare’s Medicare Advantage network in Ohio.

The practices are located across the state, from Cincinnati to Cleveland, and range from a solo practitioner to a group with 21 physicians, according to a post on the association’s website.

“While this is a positive first step, much work remains to ensure that United HealthCare Medicare advantage patients have adequate access to care. There are still a number of terminations that the OSMA remains concerned will lead to network adequacy issues for patients across Ohio,” the post reads.


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