Some Medicare beneficiaries are getting bad news related to Medicare Advantage Plans offered by United Healthcare. All across the country, doctors are receiving notice that they will not be part of the United Healthcare Medicare provider network for Medicare Advantage Plans.
This of course means that if your doctor has been terminated from the United Healthcare network, you will not be allowed to use their services unless you are going to pay out-of-pocket.
The termination of a member’s doctor will hit some harder than others. For instance, if your plan is a PPO, such as AARP MedicareComplete Regional PPO, you will still be allowed to use your doctor but will pay a higher out-of-network copayment.
If your United Healthcare Medicare Advantage Plan is a HMO, you may be out of luck. These plans generally require that you use in-network providers, without a provision allowing you to go out-of-network for a higher copayment.
Are cuts to Medicare Advantage provider networks the next thing to come?
United Healthcare is not the first insurance company offering Medicare Advantage Plans to make changes to a provider network. But they are the largest provider of Medicare Advantage Plans in the US and surely other insurance companies are watching closely. Although they argue that the changes are all about providing quality care for Advantage Plan members, we all know that money somehow factors into it.
Given the fact that Medicare Advantage Plans undergo changes every year, it probably wouldn’t warrant a second look if the cuts to Medicare Advantage networks weren’t happening all across the Country. Doctor firings by United Healthcare has become a staple news story for local media outlets nationwide. It’s gotten so much attention that United Healthcare is running a national ad to brunt the criticism. Some have even wondered if doctors with the sickest (costliest) patients were the ones getting the axe.
What should you do?
Conducting a review the the United Healthcare Medicare provider network each year is a must. It doesn’t matter if you have a Medicare Advantage Plan from United Healthcare, Humana, Aetna or any one of the number of plans that may be available where you live.
Getting your hands on a provider directory or at least reviewing one online is just part of taking responsibility. Additionally, you should also review the plan’s Summary of Benefits and Part D formulary.
If you find that your provider will no longer be in-network, you will either need to find a new provider or ask your current provider which plans he or she will be able to accept for the coming year. It’s never a good idea just to accept plan changes without doing some research. If it’s not United Healthcare provider network cuts, it could be something else.