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FMA Protests Doctor-Dropping

The Florida Medical Association is backing a Connecticut lawsuit challenging UnitedHealthcare's decision to cancel Medicare Advantage contracts.

The Association filed a brief late Wednesday supporting the Connecticut State Medical Society's attempt to block the insurance carrier from tearing up thousands of physician contracts. A judge had imposed a stay on United's cancellations, and United wants him to lift the stay so it can proceed.

Medical groups from New York, New Jersey, Texas, Tennessee and California joined the motion, as did the American Academy of Dermatology and Physicians Advocacy Institute.

"The Florida Medical Association has a substantial interest in ensuring that United not be permitted to unilaterally terminate any physician, either in Connecticut or elsewhere, in the way it has sought to do,"  said  FMA spokeswoman Erin VanSickle in an e-mail.

The FMA has been analyzing the health care insurance giant’s decision to drop hundreds, and possibly thousands of Florida physicians from its popular AARP Medicare Advantage plans for 2014, according to a memo obtained by Health News Florida.

Specifically, the group had been reviewing the recent Connecticut lawsuit, in which a judge temporarily blocked United from dropping 2,200 doctors from Advantage plans in that state.

“Although these terminations are occurring throughout the country, they are particularly troubling in Florida because of our large population of elderly residents who rely on Medicare Advantage plans for their medical care,” Association President Alan Harmon said in the memo.

“The FMA is actively researching the implications for Florida and determining what we can do to assist our physician members and the patients we serve.”

Doctors are worried that United’s decision limits patient choice and access to doctors, in particular specialists. Inadequate access is a violation of federal law, Harmon said.

Right now, it doesn’t appear the Association is prepared to sue United here. Filing a similar lawsuit in Florida would be costly, and attorneys may not find a court as favorable to the physicians’ concerns, Harmon wrote in the memo to its county associations.

Also, the FMA already has aired its grievances, Harmon said. Last month it filed a complaint with the Centers for Medicare & Medicaid Services, questioning the legality of the drastic cuts in a complaint.

United officials say despite the doctors’ complaints, patients' access to quality health care won't be adversely affected. Their physician network was uncommonly broad before, so narrowing it won't mean it is out of the ordinary, said spokeswoman Jessica Pappas.

Shrinking Medicare reimbursements and growing health care costs forced the company to make these tough decisions, she said. The reduction in payments to Medicare Advantage plans is part of the Affordable Care Act.

But Medicare Advantage plans still receive more money in premiums per patient each month than the average cost for Medicare patients not enrolled in such plans, federal actuaries say.

No one knows for sure how many Florida doctors have been dropped from United’s Advantage plans in Florida, though published reports show that it includes individual practices and physician groups statewide.

Pappas said the contract changes affect physicians only, not hospitals. It has been reported that United is dropping Moffitt Cancer Center from its hospital network, but Moffitt isn't part of the network; it is the physicians who work there who are affected.

About 1.2 million of Florida’s Medicare beneficiaries are members in 2012 Advantage plans, according to the Kaiser Family Foundation. The remaining 2.3 million are covered by “original” Medicare, which covers 80 percent of bills. To bridge that gap, some Medicare patients buy "Supplement" or "MediGap" policies.

The AARP United supplement plan is not affected by the contract changes that are causing strike with physicians, the company said.

Mary Shedden is news director at WUSF.
Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.