In late October, UnitedHealthcare began sending letters to physicians in its network outlining their rankings in the insurer's Premium Designation program for 2013. The specialties involved in the program range from family practice to rheumatology.
Nov. 26 is the deadline to appeal your ranking before United posts it on its website.
You can find information on physician rankings on the Physician Ranking page of the TMA website. The page includes Basic Steps for Reviewing and Disputing Physician Rankings & Tierings, a two-page guide on how to appeal your ranking.
United says its physician-ranking program "supports practice improvement and provides physicians with access to information on how their clinical practice compares with national and specialty-specific measures for quality, and with local cost-efficiency benchmarks in the same geography."
In the 2009 session of the Texas Legislature, TMA won passage of legislation giving physicians the right to dispute their ranking or classification before an insurance company publishes it. In addition, the law says physicians currently in clinical practice must be actively involved in developing standards used in the health benefit plan's comparison program, whose measures and methodology must be transparent and valid.
TMA remains opposed to any institution or company publicly profiling and penalizing individual physicians based on faulty methodology. That's why TMA made sure the 2009 law requires health plans to base individual physician rankings only on bona fide, nationally recognized guidelines.
If you have questions or need help, contact the TMA Knowledge Center by telephone at (800) 880-7955 or by email.
Action, Nov. 2, 2012