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UnitedHealthCare in Massachusetts

12 Jun

We all want the advantage.  We put our kids in special pre-schools so they have the advantage.  We work 100 hours a week so our kids can do 8 activities and get the advantage. Tall people have an advantage, we’re told.  Poor people are “dis-advantaged”.  Well folks, there are a whole bunch of senior citizens in Massachusetts who are about to get dis-advantaged starting September 1.

Yesterday the Boston Globe told me that UnitedHealthcare will be cutting 700 doctors, or 2-4% of it’s providers (it has 18,600in MA), from it’s Medicare Advantage plans. UnitedHealthCare is a mammoth national insurance company, and one of the main things it does is provide Medicare Advantage programs.  In fact, it’s the largest provider of such private Medicare plans in the country.  UHC has done this in 11 other states as well, and in some cases has dropped whole hospitals from it’s roster.  Why?  Company spokespeople say “they hope that streamlining the pool of doctors will not just save money but ultimately improve the quality of patient care…”.  They do not specify how quality of patient care will be improved by abruptly removing peoples’ doctors from their insurance plans.  But it will definitely save money.  And why does UHC feel it has to save money?  Because there has been a gradual reduction in the federal reimbursements to private Medicare contractors.

Why, you may ask, is the government using private, for-profit companies to provide Medicare services, and paying up to 14% more for the identical services provided by government-administered Medicare?  Excellent question.  Medicare Advantage, so called because these plans generally cover more services, like eyeglasses and prescriptions, was created after private insurers insisted that not only could they meet the medical needs of senior citizens and the disabled more cost effectively than the government, they could do so and still make a profit. (Thank you to Wendell Potter for that explanation.)  It became part of the Balanced Budget Act of 1997, but such plans have been available since the 1970s.  Well, it turned out that the claims were not true, and many of the private companies that participated dropped out when they lost money.  So the government essentially paid the companies to stay. Hence the 14% overpayment.

So.  Lot’s of money to be made.  15 million people are in Medicare Advantage plans, with payments from the government of $156 billion dollars, or 30% of all Medicare spending.  But you make more money for your shareholders if your patients don’t go to the doctor.  UHC cleared $1.1 billion dollars last year and increased it’s shareholder dividends by 30%.  So last week UHC informed a bunch of doctors in Massachusetts that they’ve been booted from the plan.  They’ll tell the patients this week. Oh, and the changes go into effect Sept 1 but you can’t change your plan until the next open enrollment period, which isn’t until October.

When UHC tried this in Connecticut, county Medical Associations filed a lawsuit and got a temporary injunction from a judge to stop UHC from dropping 2,200 doctors.  Here’s what UHC had to say about this ruling, according to Arielle Becker in the CT Mirror:

“In its statement, UnitedHealthcare said the ruling would ‘create unnecessary and harmful confusion and disruption to Medicare beneficiaries in Connecticut.  We continue to have a broad network of doctors that is designed to encourage higher quality, affordable health care coverage,’ the statement said. ‘We know that these changes can be concerning for some doctors and customers, and supporting our customers is our highest priority.'”

Right.  Because there’s no unnecessary and harmful confusion or disruption when you eliminate peoples’ doctors.

 

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5 Comments

Posted by on June 12, 2014 in Medicare

 

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5 responses to “UnitedHealthCare in Massachusetts

  1. Dennis Byron

    June 12, 2014 at 10:25 am

    The author is quite ignorant concerning both Medicare and Massachusetts (and apparently United HealthCare).

    First, in the unlikely situation that you reading this post and live in Massachusetts while looking for information on Medicare (maybe you turn 65 in a few months), you should know that United Healthcare is really AARP insurance. It is not very popular here anyways but it’s biggest problem is not whether it is accepted by 18,600 doctors or 17,900 doctors (really, author?) but whether it considers your hospital in or out of network. For example, if you live on Cape Cod, the nearest in-network hospital is in Plymouth. If you live in southern Worcester County, you have to go to Worcester or Framingham. To be clear, you can go to Cape Cod Hospital or Milford Regional but you will pay a fortune because they are out of network, Stay away from AARP Medicare Advantage in Massachusetts; there are a half dozen better choices.

    Second, as for the outright lies in this article,
    1. all Parts of Medicare, not just Part C Medicare Advantage, are run by ” private Medicare contractors.” If you care, you cannot avoid them. But there is no reason to care.
    2. many of the “private Medicare contractors” (and most of the ones involved in public Part C Medicare Advantage) are not “for-profit companies.” Again, there is no reason to care because both the non-profits, the mutuals and the for-profits are so strictly regulated as to how much profit/reserve they can have that it makes no difference
    3. No one is paying up to 14% more for the identical services provided by government-administered Medicare? There are two lies in that sentence:
    — it’s not 14%; it’s 3% (it was 14% for one year for some plans, mostly for the disabled)
    — it’s much better than the services in Original Medicare (which is what I assume the author means by “government-administered Medicare,” even though there is no such thing) primarily because it includes annual out of pocket spending limits and Original Medicare does not and can bankrupt you unless you make other arrangements (which 98% of us seniors do)
    4. Public Part C Medicare Advantage health plans receive the kicker because they disproportionately serve the poor and minorities; if the author wants to get rick of the kicker, suggest another way to help the poor

     
  2. Ramona

    June 13, 2014 at 5:52 pm

    So, Dennis, what’s your take on the class action lawsuit that UHC had to settle?

     
  3. Shirie Leng, MD

    June 14, 2014 at 4:33 pm

    Dennis – Thanks for reading. All of my information comes from the following sources: Boston Globe, Medicare.gov, and anything written in the New York Times by Uwe Reinhardt.

     
  4. qualityhealthcareplease

    June 14, 2014 at 7:21 pm

    I am guessing you are unhappy because your employer or retirement plan uses United Health Care. UHC drops your doctor so you are forced to find a new doctor — that is really crummy. I feel it would be important to complain to the employer that chose UHC. Health plans usually pick the least expensive companies and not the highest quality. Behind all the smoke UHC has a problem — they are likely a 2 or 3 star quality operation. Their quality is so low they did not want to be listed on the health care exchanges — any reasonable consumer would not pick them and their business would suffer. Firing doctors they claim are providing poor quality is totally contrary to any idea of quality improvement. It’s the system not the people!

     
  5. Ramona

    June 16, 2014 at 7:37 pm

    Exactly, I’d noticed in the past that UHC tends to go for the lowest cost providers, period.

     

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