This problem is expanding into Kentucky now.  I have heard it for years in California with different doctors groups over and over complaining that their net reimbursement from United Healthcare is less than Medicare.  For those why buy insurance plans from exchanges, in many areas United pays somewhere between Medicare and Medicaid rates and that they have published themselves.   In California, complex contracts are used as part of the tools to keep the compensation low.  We keep reading all the time about the expense of doctors and a while back there was a study that came out and it said doctors are not that expensive compared to all the other costs in healthcare.

So if you do find your doctor not in network with United, this could be part of the problem, being paid at ratesimage that are 12% average less than what Medicare pays.  Of course, our current CMS head, Andy Slavitt drove this payment factorization to pay doctors less during his time at United Healthcare, so if confirmed at Head of CMS, that’s what’s there for those who are members, paying doctors even less and dumping more cost to the consumer.  The doctors in this group said they have not had a raise in 6 years with United.  Sometimes doctors are accepting less than Medicare and still get fired from United if the algorithmic formulas United uses says no, so they get fired by the algorithms as well. 

United Healthcare Extending Narrow Networks in California–More Secret Scoring of Doctors in the US–Telling The Doctors If They Are “Allowed” To Be In Network…
“The Secret Scoring of America’s Physicians” - Algorithmic Math Models For Insurance Network Contractual Exclusions, Relating to MDs Who See Medicare Advantage Patients..

The company also has a law firm in New York looking into the reimbursement issues.

Law Firm Investigating UnitedHealthCare Claim Payments in New York Stating Under-Reimbursement By Manipulating Algorithmic Benefit Calculations…

A couple  yeas ago the American Academy of Family Practice doctors took up this issue as well with United paying doctors at at rates less than Medicare, so it’s all over the US as an issue.  Don’t be fooled anymore and think that commercial insurers make up for the low payments of Medicare as they don’t always anymore.  There’s enough here in this post to substantiate that. 

AAFP Says We’re Not Going To Take It Anymore With Optimization of Provider Networks - Specifically United Healthcare’s Doctor Dumping That Disrupts Continuity of Care

Is there any reason why doctors are not really happy with United?  Here a couple years ago they put out an article telling the Feds to aggressively manage seniors and they are trying not only manage seniors but everyone else it seems.  BD

United HealthCare Issues Another Study, This One Telling Government To Aggressively Manage Medical Care For Seniors-An Area Where A Large Chunk of Their Revenue Comes From Today, Managing Care

It’s really not fair to the other insurers as well to have this United/Optum monopoly at HHS and CMS that exists today and has been around for years.  CMS now is stuck with a lot of the mentored United models that are not working so well as that’s all they do is numbers when it comes to insurance.  BD 

Local doctors who are part of Highland District Hospital’s Professional Services Corporation will no longer be part of the United Healthcare network because they say United’s reimbursement rates have not been increased in six years.

The doctors say the rates have remained unchanged even after three years of negotiations, and that current rates are, on average, 12 percent lower than even Medicare rates as well as the rates paid by most other commercial health insurance carriers.


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