Attention Seniors: Merry Christmas from AARP-Endorsed Obamacare

Dec. 21, 2013

Seniors scrambling after United Healthcare drops doctors from Medicare Advantage 


A popular, AARP-endorsed Medicare plan is dropping a large number of doctors from its network, generating cries of outrage nationwide from older patients and medical groups who say the seniors were not given enough time to shop for new insurance.

AMY NEWMAN/STAFF PHOTOGRAPHER

Dr. Lee Angioletti, a retinal specialist, performing a laser treatment on Jeffrey Charles of Fort Lee. Angioletti was recently dropped from the United Healthcare Medicare plan.

Betty Baker, 70, of Wyckoff, said she was notified in late November that the Medicare Advantage plan operated by United Healthcare would be dropping four of her longtime doctors on Feb. 1, including the eye doctor who recently performed her cataract surgery.

“My husband and I knew this has always been considered one of the best plans, so we didn’t know if it made sense to switch,” said Baker, who ended up reenrolling even though her husband also had his primary care doctor dropped. “We didn’t have a whole lot of time to decide what to do.”

Complaints about the changes to United’s Medicare Advantage plan, which provides HMO-like coverage to seniors, are building nationwide. Medical societies in New Jersey, New York, Ohio, Connecticut and other states as well as senior groups say a substantial number cardiologists, eye doctors and other specialists widely visited by older people with chronic conditions have been dropped from United’s network.

Locally, many individual physicians are appealing to be reinstated. A doctor’s organization in Connecticut went to court and persuaded a judge to stay the terminations in that state. And 82 state and national physician’s groups signed a letter asking federal regulators to have the changes put on hold, questioning whether the networks will have an adequate number of physicians in each region.

United Healthcare would not disclose the exact number of doctors dropped from its New Jersey network. A company representative said that nationally, the insurer’s 2014 network of providers will be between 85 to 90 percent of its current 2013 size. The representative, Jessica Pappas, also said the company has long had one of the larger networks and will continue to comply with the federal government’s standards for having an adequate number of geographically accessible doctors, hospitals and other providers.
“Our networks will continue to meet, if not exceed, Medicare standards,” Pappas said.

Seniors have a short window each year — from Oct. 1 to Dec. 7 — to decide which type of Medicare plan they want in the coming year.

Most choose what’s called traditional Medicare, which is open to all doctors who want to participate. But growing numbers opt to go with all-inclusive HMO-like plans offered by private insurance companies, which can save a senior from having to buy more expensive supplemental insurance to get dental, vision and other benefits not offered under the government-run Medicare plan. As a trade-off, these so-called Medicare Advantage plans require participants to go only to doctors and hospitals included in their networks.

The Medicare Advantage plan offered by United Healthcare — which bears the stamp of approval from AARP, the nation’s largest senior-citizen advocacy group — is the biggest seller nationwide, with more than 3 million enrolled, including 79,000 in New Jersey. Its lure is that it has no monthly premium on top of the Medicare fee subtracted from a retiree’s Social Security check.

The notifications about dropped doctors — which some plan members say arrived too close to the re-enrollment deadline — forced many seniors to choose between keeping their monthly costs down or staying with doctors they’ve been using for years for the treatment of glaucoma, heart disease or age-related conditions.

Pappas said the company is required to notify plan members of network changes 30 days before a provider is removed but strived to send letters more than two months ahead of that deadline. The letters recommended alternative doctors their members could choose, she said.

“We certainly understand that these changes can be concerning,” Pappas said. “We are doing our best to address those concerns.”

To William Burke, a 72-year-old Elmwood Park resident who has emphysema, high blood pressure and severe glaucoma that has left him blind in one eye, the concerns about changing doctors were too great. He decided to switch to a more expensive plan when he was notified that his cardiologist and ophthalmologist were being dropped.

He had already unsuccessfully tried to appeal when his primary care doctor and pulmonologist were terminated from the plan’s network earlier this year.

“They really threw me under the bus,” Burke said.

“I’m up in years, and I’m kind of on a banana peel, health-wise,” he added. “When you’re older and you have health issues, you need these maintenance doctors, and you need to be comfortable that those doctors know you and know what you need.”

Burke will now pay an additional $153 a month for a Horizon Blue Cross Blue Shield plan, which includes all of his doctors.

“I’m not going to renew that AARP membership either,” he said. “They aren’t much use to me.”

AARP, which helps fund its advocacy by selling the rights to its name to insurers looking for its endorsement, has been affiliated with United Healthcare since 2007, but has no say in administering the company’s Medicare plan, said David Allen, an AARP spokes¬man.

“AARP has no input on individual decisions about what doctors, hospitals, etc., companies contract with in building their networks,” Allen said in a statement. “What we can and will continue to do is to provide any affected member with information that can help them make health coverage decisions for themselves and their families moving forward.”

But Betty Baker complains that such decisions are not easy to make, particularly because insurers can alter networks at any time during the year. She still hasn’t found replacements for her primary care doctor, gynecologist, rheumatologist and ophthalmologist and is upset that a booklet the company sent her with a list of included doctors incorrectly contained the name of her gynecologist. “The list isn’t even accurate,” she said.

Specialists who were dropped from the United Healthcare plan argue that, for seniors who are forced to switch doctors, the disruption could compromise care. “The patients that we see have debilitative conditions,” said Dr. Lee Angioletti, a Fort Lee retinal specialist whose practice was dropped. “They are often on a schedule to receive injections or treatments.”

Angioletti is also concerned that many of his more than 250 Medicare Advantage patients were referred to general ophthalmologists who don’t have the same expertise in treating retinal problems.

Dr. Hadley Phillips, medical director of Philips Eye Center in Elmwood Park, lodged an appeal of his practice’s termination to United Healthcare. He said the insurer’s decision will affect 1,500 of his patients.

United Healthcare acknowledges it has received numerous complaints and questions from its Medicare Advantage members, as has AARP. The insurer is open to appeals from doctors who believe they offer specialized care their patients need and from seniors who are post-surgery or in the middle of extended treatment, Pappas said.

“For those instances where there are specific concerns, we encourage them to contact us,” Pappas said.

She would not discuss the specifics of why some doctors were removed but said the company relied on a new Medicare star rating that seeks to reward physicians who score well on a range of quality and cost-containment measures.

Physician groups have asked the Centers for Medicare and Medicaid Servicesto put the terminations on hold and to review whether enrollees were given enough time to choose a different plan and whether United’s network has a diverse enough offering of providers in each region.

Medicare officials, however, said they do not have concerns that United’s network is too small or that seniors were not given enough notice.

Meanwhile the Medical Society of New Jersey filed a brief in support of the Connecticut lawsuit and made its concerns known to members of Congress.

“This is important to seniors,” said Melinda Martinson, general counsel of the Medical Society of New Jersey. “They are not making informed decisions about their plan selection if they don’t know whether or not their physician of choice will be in the plan the following calendar year.”


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