federal appeals court has refused to allow UnitedHealthcare to continue kicking
physicians out of its Medicare Advantage plans. On Dec. 12, the court declined
United's request to lift an injunction against the insurer and referred the
case to a three-judge panel. The appeals court ordered the parties in the
lawsuit to file briefs later this month.
and other state medical associations had asked the court to keep the injunction
in place until the dispute in resolved in the courts.
lawsuit originated in, and currently applies only to, Connecticut. However,
attorneys for TMA and other medical societies are trying to expand the case
nationally because physicians in Texas and other states are affected, said TMA
Vice President and General Counsel Donald P. Wilcox. For example, he said, TMA
has been told 1,100 physicians in Houston were notified they are being
The brief that TMA and the other associations filed says the appeals court should
maintain the injunction because it "temporarily keeps in place the
arrangements between United and physicians that have functioned for
years." Terminating the physicians will cause them "irreparable harm,"
but keeping the injunction in place will not hurt United, they said.
contends the injunction interferes with its right to manage its physician
and the other medical societies told the appeals court the lawsuit serves the
interests of their members because "United's improper termination of
physicians from the [Medicare Advantage] network would negatively affect other
physicians, who would have to bear the burden of serving Medicare patients (at
low Medicare rates) who would start coming to them in the absence of their
regular doctors. This would place an undue strain on the physicians and
practices left remaining in the network, and potentially compromise those
providers' doctor-patient relationships with their other patients. In addition,
under United's unilateral amendment justification, all physicians in United's
networks remain subject to termination at any time and for any of United's
products. Thus, in challenging United's use of this method of termination, the associations
are protecting all of their members' interests."
TMA, state medical societies filing the brief included California, Florida, New
York, New Jersey, and Tennessee.
November, TMA, the American Medical Association, and numerous national
specialty societies and state medical associations told the Centers for
Medicare & Medicaid Services (CMS) that United and other insurers were
terminating physicians from Medicare Advantage plans. They said in a letter
to CMS that such insurers are undermining patients' rights and denying them
access to care. They asked CMS "to take immediate action" to make
sure Medicare beneficiaries participating in these plans "have accurate
and reliable information to make health insurance elections during the 2014
Open Enrollment period …"
letter says hundreds of physicians reported they were terminated from the
United Medicare Advantage networks. "The terminations are 'without cause'
and have been timed in a manner that undermines the accuracy and reliability of
the information Medicare beneficiaries are relying upon in order to make
important health care decisions for 2014 health insurance coverage. The timing
and process used to communicate the terminations and modifications to the
networks are not consistent with CMS guidance and regulations," the letter
added that the terminations "will disrupt long-established
patient-physician relationships, interfere with existing physician referral
networks, and undermine emergency department coverage in many hospitals. Both
the continuity and coordination of care will be negatively affected, and
treatment for certain types of care commonly provided by a very limited number
of sub-specialists may no longer be available within the network."
and the others urged CMS to extend the Medicare Advantage open enrollment
period and require plan sponsors that have reduced their networks to
and document that patients received actual and accurate notice of whether their
current physicians will be in the 2014 network;
that patients know they can retain their physician by choosing fee-for-service
or by choosing a product with an out-of-network benefit if their plan provides
physicians information they need to challenge network adequacy based on CMS
regulations and extend the appeals deadline until physicians receive such
AMA and the state medical societies how many patients are impacted and which
physicians were terminated; and
- Direct plans to hold
all terminations initiated just before or during Open Enrollment 2014.
Action, Dec. 16, 2013