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Medical Society Condemns UnitedHealthcare Medicare Advantage Physician Network Reductions

Thousands of area seniors will be forced to change doctors or pay much higher out-of-pocket costs

The St. Louis Metropolitan Medical Society, representing more than 1,300 member physicians in the St. Louis area, is protesting recent actions by UnitedHealthcare (UHC) to terminate a large number of local doctors from its Medicare Advantage physician network. The terminations will force thousands of area seniors to change doctors or pay much higher out-of-pocket costs if they continue to see their physicians outside of the network.

“These terminations are occurring without cause or explanation, and threaten long-established physician-patient relationships. UnitedHealthcare’s actions will force many of our older patients to find new doctors,” said Joseph A. Craft III, M.D., 2014 Medical Society president and a St. Louis cardiologist. “Older patients with disabilities or limited incomes will be strong armed to find care in a new environment, often having to travel significantly greater distances, or be faced with paying higher out-of-network costs to continue to see their current doctors,” he added. “UHC’s actions are unconscionable.”

An initial round of termination notices was sent in April to local doctors with a July 1 termination date. A much higher number of notices were sent earlier this month to St. Louis physicians with a September 1 date terminating them from UHC’s Medicare Advantage network.

The Medical Society estimates that hundreds of local physicians have been impacted across all specialties, but the recent action appears to be concentrated among cardiologists, dermatologists, ophthalmologists, gastroenterologists and orthopedic surgeons – all specialties with a high senior patient population.

George Hruza, M.D., a Chesterfield dermatologist and president-elect of the American Society for Dermatologic Surgery, is one of the physicians included in the network terminations. “Our research indicates that at least 36 (about 49%) of St. Louis area dermatologists are being terminated by UHC,” he said. “Among independent private-practice dermatologists, more than two-thirds in the St. Louis metro area have been terminated leaving large portions of the region without a dermatologist.”

“Many physicians trained in specialty procedures such as Mohs Surgery, which achieves a 99% cure rate for the most common type of skin cancer, have been eliminated from the network,” Hruza continued. “This will reduce access for UHC Medicare Advantage’s members to these highly specialized services in a timely manner.”

UHC’s actions are occurring during the middle of the plan year, with the next open enrollment period for senior health plans not scheduled until late 2014. This will strand thousands of older patients and force them to find a new physician in the middle of the enrollment year, and possibly mid-treatment.

UHC’s termination notices have not been limited to Missouri. Over the past several months, physicians in as many as 11 other states have been dealt a similar fate. The terminations to date only impact Medicare Advantage networks.

“The St. Louis Metropolitan Medical Society works hard to protect patients and optimize the physician-patient relationship,” said Dr. Craft. “A doctor being terminated from an insurance contract should be provided data contributing to the decision and an opportunity to remediate the situation. That is not happening with these termination notifications, and potentially thousands of St. Louis area seniors will be losing access to their physicians. United Healthcare’s unilateral actions are a threat to optimal patient care, and are completely unacceptable.”


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