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  • Writer's pictureBrian A. Raphan, Esq.

Senate Looks at Doctor-Dropping by Medicare Advantage Plans:

What to do when Medicare Advantage insurers drop large numbers of doctors from their plans?

On Jan. 22, members of the Senate Special Committee on Aging met in Hartford, Conn., in search of an answer. UnitedHealthcare, the nation’s largest Medicare Advantage insurer, planned to drop its contracts with some 2,250 doctors in the state on Feb. 1, but a court has ordered the terminations delayed while the issue is being litigated.

Raymond H. Welch, a dermatologist in Rhode Island, told the committee that when Medicare Advantage plans can summarily drop providers, it leaves doctors focused on pleasing the insurer instead of advocating for their patients. “It is this perversion of the doctor-patient relationship that I fear the most,” Welch said. “It is said you cannot serve two masters. The master that physicians serve must be their patients, not UnitedHealthcare.”

But attorney Stephanie Kanwit, testifying on behalf of America’s Health Insurance Plans, the industry’s national trade association, countered that insurers need the freedom to drop doctors from their networks.

“As a direct result of the serious funding challenges facing the Medicare Advantage program,” Kanwit told the committee, “the need is greater today than ever before for innovations that deliver increased value to beneficiaries with the increasingly limited resources that are available to support the MA program.” Insurers, she said, are looking at which medical providers are most cost-effective as well as which score best on measures of quality care.

Richard D. Johnson, a retiree who lives in Bridgeport, Conn., said he was disappointed and confused when the doctor he trusted was dropped from his Medicare Advantage plan.

“I just want to see the doctor who has been taking good care of me for three years,” Johnson testified. “ I want to say that I am not just worried about myself. There are lots of other seniors who are affected by this. … When you have health problems, you want to stay with the doctors who know you personally and take excellent care of you.”

Posted on 01/27/2014 by Tamara Lytle | Washington Watch | 




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