Docs can challenge UnitedHealth's Medicare Advantage cuts, court rules


A federal appeals court has denied UnitedHealthcare's request to dismiss a lawsuit brought by doctor associations in Connecticut after the insurer dropped 19 percent of its Medicare Advantage network, the Hartford Courant reported.

Instead, the 2nd U.S. Circuit Court of Appeals in New York modified a previous injunction temporarily preventing UnitedHealth from cutting the doctors. Now the affected providers have 30 days to challenge UnitedHealth for dropping them from its Medicare Advantage network. The doctors also can seek emergency relief to remain within the network.

Fairfield County Medical Association, one of the two organizations suing UnitedHealth, said the decision means UnitedHealth will have to explain why it cut the doctors from its network.

"We think that this case is precedent-setting," Executive Director Mark Thompson said in a statement. "It's telling the insurance companies that you can't just drop physicians from your panel. You've got to give them a good, bona fide reason why you're dropping them."

The group said it will start notifying its members this week about how to proceed with arbitration, according to an announcement.

Meanwhile, UnitedHealth said it will begin working with doctors. "We are pleased that the court determined the injunction should be lifted in short order and are happy to work with physicians who have concerns about their status, even as it remains essential to offer networks that provide better health outcomes and more affordable coverage for our members," UnitedHealthcare spokeswoman Jessica Pappas said in a statement, the Courant noted.

The case is part of a larger trend of providers fighting back when insurers drop them from networks. Just one example: Frisbie Memorial Hospital in Rochester, N.H., one of 10 hospitals ousted from Anthem Blue Cross Blue Shield's provider network for individual health plans, is fighting to rejoin the ranks of participating providers, as FierceHealthPayer reported yesterday. 

To learn more:
- read the Hartford Courant article
- see the Fairfield County Medical Association announcement

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