Sticking with the story
The Springfield News-Sun has reported on local doctors being dropped from UnitedHealthcare’s Medicare Advantage provider network since the story first broke last October.
UnitedHealthcare has extended Medicare benefits to thousands of Clark County customers who may not have been notified of impending changes to physicians inside its provider network. Local doctors, however, say nothing has changed regarding their status with the insurance company and that residents still might have to seek care outside of Clark County.
“They’re delaying the inevitable,” said Dr. Rick Nedelman of Springfield. “The facts remain the facts. They’ve excluded thousands of physicians and angered thousands of patients.”
Approximately 5,000 UnitedHealthcare members with the Medicare Advantage plan did not receive notification that their physicians were going to be removed from their provider network on Jan. 1 because of a database glitch. Patients should have been notified in October per network rules, according to the Ohio State Medical Association.
Because of the error, the company will treat claims associated with the affected physicians through March 31.
A review has confirmed limited markets in Ohio were affected by the lack of notification to members participating in the Medicare Advantage plans. The company has implemented new quality assurance steps to prevent a similar error from occurring in the future.
“We deeply regret any confusion this error has caused for our members and their physicians,” UHC spokesman Kevin Shermach said in a statement. “We have taken action to support these members.”
Last October, at least 50 Clark County doctors received termination letters from the insurance company, informing them of the decision, according to local doctors.
UHC will compensate approximately 660 out-of-network physicians who provide care to those members affected by the notification issue. They’re also reaching out to physician offices to avoid any disruption caused by the lack of notification.
The company also will notify those members by mail about the changes and reassign them to doctors to a new primary care physician.
Nedelman compared the situation to what happened with the government’s rollout of the Affordable Care Act website.
“To me, it’s bureaucracy at its finest,” Nedelman said. “They’re staying very firm to their business plan.”
The OSMA has asked the Centers for Medicare and Medicaid (CMS) for clarification on patients’ rights in regards to changing plans since the open enrollment period expired before they were notified of their doctors’ termination, according to a press release.
Currently, a patient’s only option is to drop their Medicare Advantage plan in favor of traditional Medicare.
However, OSMA believes if patients aren’t granted another window to change Medicare Advantage plans, they should be allowed to receive care from “impacted physicians” until the next open enrollment period begins at the end of the year.
Nedelman believes many of his patients may have already switched plans.
“It’s really been difficult for people,” Nedelman said.
Donna Reynolds, 73, of Springfield, and her husband, Carton Reynolds, 78, recently switched from a UnitedHealthcare to an Aetna Medicare Advantage plan after learning three of their longtime specialists — including Nedelman, Dr. Trent Carroll and Dr. George Varghese — would be dropped from their provider network. The Reynolds’ primary care Dr. Ajaz Umerani was also available through Aetna.
“We didn’t want to start all over with somebody else,” Donna Reynolds said.
She attempted to get some answers from UnitedHealthcare, but they “basically told me ‘tough luck.’ ”
Reynolds said both she and her husband have major health problems.
“We don’t need that type of frustration and aggravation at our ages,” Donna Reynolds said. “We have enough to deal with our health and so forth that we don’t need these insurance companies treating us as if ‘oh well, we’ll just drop this one and that one.’ .”
While the Aetna plan’s provider network did include their physicians, Donna Reynolds said the plan had some differences with their prescriptions.
“It’s not something we can’t work out with our doctors,” Donna Reynolds said.
Nedelman is unsure if any local doctors won appeals to stay within the Medicare Advantage plans. In December, 10 practices in southwest Ohio, including a large gastroenterology practice in Dayton, were reinstated to the Medicare Advantage network, but OSMA could not confirm if any were located in the Springfield area.
UnitedHealthcare serves approximately 102,000 individual Medicare members in Ohio. The company encourages customers with questions to call 1-888-332-8883.
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