This is not the first time the AAFP confronted United Healthcare as they did back in 2012 when they were getting complaints from doctors across the US that they were getting paid at rates less than Medicare.  I hear it all the time in the OC imagewith doctors telling me by use of complex contracts, their net pay is less than Medicare pays.  Below is the link from a couple years ago and nothing on that front has changed. 

The AAFP Confronts United Healthcare On Reimbursements, Some Are Below Medicare Rates In Parts of the US–Payment Algorithms/Formulas Calculated Deep Within IT Infrastructures Do the Job

In addition this article goes on to state how the AAFP has now joined in the lawsuit filed in Connecticut and that was made possible by a little publicized ruling from the Supreme Court last year that now allows physicians to group to litigate.  For years it has been in the contracts that doctors had to sign to be in network that they agreed to allow it to always be one doctor against the corporation should they have a dispute, so how fair was that?  Oxford, fought it tooth and nail for years and spent a lot of money I would guess until it landed at the Supreme Court and of course premium money pays for that.  The California Medical Association as well as the Texas Medical Association and a few others are also partnered in on this lawsuit. 

US Supreme Court Rules Physicians Can Work As A Group To Fight Unfair Business Practices of Health Insurers–Victory Over United Healthcare (Oxford Subsidiary)–Context Once Again With Contracts

The argument presented here is the disruption of patients and doctors interfering with care and we know that happens.  Sometimes changes work and sometime they don’t and as people get older, change is harder to do.  What’s almost kind of amusing is the link below as we all know about narrow networks now and the fact that United went out and bid a Medicare Advantage contract, won it and then found out through their own doing, they didn’t have any providers in the area the contract covered, already narrowed it down to zero in that area. 

Howard County School Board in Maryland Rescinds United Healthcare Contract As Retirees Didn’t Want the Medicare Advantage Plan, No Providers Available..

It’s all done with those little “Algo Men” at United with numbers only so algorithm says, “MD is fired”. 

United Healthcare Medicare Advantage Doctor Firing Moves On Into Ohio, New York, And Maybe More? CMS Has Known For Months About the Changes And Is Monitoring….United’s Cost Algorithm Says…You’re Out the Door

The AAFP letter to Tavenner at CMS they wrote, well who knows as we have Andy Slavitt at the number two job at Medicare and we just all pretty much predict he’ll be leading her around by the nose as she had not data mechanics logic so more duping on the way I think.  There’s no appeals process for patients who have to find a new doctor and no doctors are getting any real explanation as to why they were cut loose and we know that was an algorithmic process. 

How Hard Did United Have to Lobby To Get Someone In The Deputy Administrator Job at CMS? Sebelius Syndrome Lives On With Burwell, In Good Company With Mary Jo White and Richard Cordray To Name A Couple Others…

Burwell has been nothing to write home about either and just seems like she’s one that will follow probably follow orders from Andy Slavitt as well because she’s over her head.   If you remember back Andy Slavitt was the President of the United company, Ingenix, which is now renamed Optum when the lawsuit was settled by the AMA for underpaying doctors for 15 years so is that not a great guy to have as the #2 person at Medicare? 

In addition we have this guy, Ezekiel Emanuel that hangs around DC with Andy and what dangerous person he is.  Emanuel got a lot of attention for wanting to legalize euthanasia and he basically thinks doctors should be more like robots and is just a sick thinking puppy overall that shows little compassion and he just loves all the analytics that United Healthcare produces and thinks they walk on water as well. Nobody I talk to including a former CMS employee can stand the man.  And finally the AAFP wants to know if you have been cut loose by United or any other insurance company.  BD

“If you have received a letter from an insurance company notifying you that you or your practice is being dumped -- oh, excuse me, “optimized out of network” -- please notify your AAFP chapter. We are in close contact with the chapters on this issue, and it benefits our efforts to organize actions by states and regions.”

Hundreds of family physicians recently have been informed that they are no longer eligible to provide care to patients covered by certain insurance policies. Sadly, most of these physicians were not notified directly by insurers. Instead, patients told the affected physicians that they received a letter stating that their family physician is no longer covered by their insurance plan. These patients and their family physicians were not given any justification why these actions are being taken. They were only given a date on which their relationship would be terminated. These patients are rightfully upset, their family physicians are mad, and the AAFP is taking aggressive action.

To quote the 1980’s rock band Twisted Sister, “We’re not gonna take it.” Last week, the AAFP wrote letters to America’s Health Insurance Plans (AHIP) and United Healthcare notifying them of our concerns and urging them to take a more responsible approach to the formation of their provider networks – especially with respect to primary care physicians.

We also wrote a letter to CMS Administrator Marilyn Tavenner, M.A., expressing concern with actions taken in Tennessee with respect to TennCare, the state’s Medicaid program. TennCare, operated by UnitedHealthcare Community Plan, recently informed hundreds of individuals that they would need to change primary care physicians or face higher out-of-pocket expenses for their health care.

Our recent actions are in addition to the "friend of the court" brief the AAFP joined, along with several other medical societies, in support of two Connecticut medical associations that sued United Healthcare in 2013, challenging its actions to summarily “dump” more than 2,000 physicians from its Medicare Advantage network in the state of Connecticut.

We recognize that insurers have a responsibility to align networks of physicians and hospitals to maintain affordable premiums while ensuring quality and efficiency, but we feel that disruptions to the patient-physician relationship at the primary care level are contrary to both of these goals. Primary care is relatively inexpensive as compared to specialty or hospital care. It also benefits from continuity and trusting relationships. We are baffled by the language used by insurers who say they support patients having a continuous relationship with a primary care physician and then act in a way that make this impossible. In short, we are no longer flattered by insurers’ language that speaks to our policy goals but are demanding action that aligns their public comments with their actions in the health care market place.


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