- UnitedHealth Group continues to cut Medicare Advantage providers around the country from their networks. Although no official figures have been announced, a spokesperson for the insurer said they expect to reduce their networks down to 85% or 90% of their 2013 size.
- United officials told the Medical Association of Georgia to expect the Medicare Advantage network to be cut by 10% by Sept. 1; Tennessee expects 500 physicians to be eliminated by Aug. 15; in Massachussetts, an expected 2% to 4% reduction equates to a loss of 744 physicians out of the network's 18,600 providers.
- Physicians do have the right to appeal, and patients may also appeal to the insurer to continue covering their current doctor for a finite time in specific circumstances of ongoing care like chemo and post-op rehab.
United, which is the nation's largest provider of privately-managed Medicare Advantage plans, took similar actions in Rhode Island and Connecticut last year to help curb costs. While there is pending legislation in Washington that would prevent insurers from dumping providers in the middle of the year, the reductions are a direct response to the ACA's shrinking reimbursements to private insurers that offer MA plans — a new reality that payers must adjust to accordingly:
"Network restructuring is the new normal. It’s not just UnitedHealthcare, but that’s the way health plans will be operating in the future,” UnitedHealthcare’s chief medical officer Dr. Sam Ho said. “Healthcare is going through so many significant changes that it’s no longer a matter of doctors providing services and health plans paying claims, but a focus on the quality and cost effectiveness of those services.”