UnitedHealthcare drops BIHS providersLocal Medicare Advantage patients affected
UnitedHealthcare of R.I. has terminated the ability of all four of the healthcare providers at the Block Island Health Center from participating in its Medicare Advantage plans. The announcement was made this week by Executive Director Barbara Baldwin after she received word from UnitedHealthcare on Oct. 2.
According to Baldwin, that notification reads, “UnitedHealthcare is amending your agreement referenced [in their letter] to discontinue your participation in the Medicare Advantage Network, effective February 1, 2014.” That network has enrolled approximately 36,000 Rhode Islanders.
According to Baldwin, there are 24 patients on the island who are members of Medicare Advantage. “To our knowledge, none of the Medicare Advantage patients on Block Island have heard from UnitedHealthcare,” she said.
This seemed to be true across the state as well, as reported in the Providence Journal (Oct. 21), which noted the action surprised and “outraged doctors who were eliminated” and “narrowed the choices for thousands of elderly patients in Rhode Island.” She explained that BIHS had submitted an appeal, which was received by UnitedHealthcare on Oct. 11, within the allotted time period.
The Journal article also cited Larry Grimaldi, a spokesperson for Rhode Island Department of Elderly Affairs, who suggested just under 100 physicians had been dropped.
According to Grimaldi, the burden of discovering the status of their coverage seems to fall on patients whose only recourse is to check UnitedHealthcare’s revised provider directory to learn whether or not their physicians are in the network.
On the same day as the Providence Journal report, Elaine C. Jones, MD, President of the Rhode Island Medical Society, Kathleen C. Hittner, MD, Health Insurance Commissioner and Health Care Advocate Jodi Bourque addressed a letter to Dr. Michael Fine, Director of the Rhode Island Department of Health (DOH) and to Paul McGreevy, Director of the state Department of Business Regulations, asking for intervention in order “to avert harm to patients.”
The Medical Society explained it had been contacted by physicians from a wide range of specialties, “who are being terminated by UnitedHealthcare, including family medicine, general internal medicine, general surgery, otolaryngology, ophthalmology, cardiology, dermatology, endocrinology, pulmonology and rheumatology.”
The Society pointed out that each of these physicians also knew of other colleagues who had been dropped by UnitedHealthcare. Jones and the others also “confirmed that at least one community health center, namely BIHS at 6 Payne Road, which is the only community health center serving Block Island, is being dropped from United’s Medicare Advantage network.”
The Society’s objection seemed to rest on the charge that “UnitedHealthcare is implementing a ‘material modification’ without due notice to the Department of Health and Department of Business Regulation, let alone to those who are most deeply affected, namely the patients of these physicians.”
Citing Rhode Island General Law 27-41-3, Jones and colleagues underscored its provisions: “A licensed health maintenance organization shall … file a notice describing any material modification of the operation, including, but not limited to systematic changes in provider networks and mechanisms for the management and control of the use of covered services by enrollees, set out in the information required by subsection (B) of this section. The notice shall be filed with the director [of the Department of Business Regulation] and with the director of health [DOH] prior to modification. If the director of health does not disapprove within ninety (90) days of the filing, the modification shall be deemed approved.”
The Society’s letter suggested that the effects of UnitedHealthcare’s actions were that “many thousands of Rhode Island patients stand to lose access to their physicians and experience disruption and discontinuity of care …” It asked the DOH and the Department of Business Regulation to act quickly to rectify the situation created by UnitedHealthcare.
The letter added that in the knowledge that the Center for Medicare and Medicaid Services (CMS) “has clear standards for network adequacy for Medicare Advantage plans,” the Society was simultaneously appealing to the CMS administrator.”
Responding to an “open letter” in the Providence Journal, published on Oct. 19 that was written by UnitedHealthcare to its Medicare Advantage members, Baldwin wrote her own letter-to-the editor (see B.I. Times letters section). Baldwin cited UnitedHealthcare’s claim that it offered “high quality and expansive networks of physicians, specialists and other providers to choose from.” She noted “they … continue to offer broad choice in access to care.”
Baldwin pointed out these most recent actions belied the promises: “All our clinicians received a letter notifying them” of the termination of their participation in the Medicare Advantage network without statement of cause, she wrote. Noting the island’s small size and distance from the mainland, she said while UnitedHealthcare was suggesting patients select other providers, for islanders, that would mean “travel to the mainland for care,” either by ferry or plane. This travel, she explained was subject to the variables associated with island weather— “fog and high winds, which can cause cancellation of ferries and planes.”
She explained that dropping Medicare Advantage patients on island would essentially leave them without insurance coverage — “forced to pay out of network rates or… 100 percent of the cost.”
Baldwin questioned how these outcomes would “provide a higher quality of care or more affordable care for the residents and visitors on Block Island.” Concluding, she wrote, “What UnitedHealthcare has done is to drop the only source of medical care [for Medicare Advantage members] on our island.”
There may also be an impact on the island’s tourism industry, as well, Baldwin said. “If people who are covered by Medicare Advantage come to the island, they may find themselves without coverage here,” she wrote.
Baldwin has also drafted a letter to Dr. Fine at the Department of Health to request that he “declare this [United’s actions] a ‘material modification’ of our contract and to intervene in our behalf.” Reaching out to visitors and residents of the island, who are covered by UnitedHealthcare, Baldwin urges them “to write to Dr. Fine as well and express their concern.”