UnitedHealthcare Medicare Advantage practices in Florida raise eyebrows in Illinois.

UnitedHealthcare won the bid to be a Medicare Advantage provider in Illinois.

The decision impacts state retirees who are Medicare eligible.

So it caused many eyebrows to be raised when it was reported that United-Health Care’s AARP Florida Medicare Advantage plans are dropping patients with little notice.

The UnitedHealthcare Medicare Advantage Illinois state retiree plan is unique to state retirees and may differ from the Florida offering.

Patients have received letters telling them to seek new physicians if they want to stay on the plan. Doctors — United won’t say how many — have learned that AARP plans will stop paying for their services next year.

The changes affect some of the area’s larger providers, including St. Luke’s Cataract & Laser Institute, Tampa Eye Institute and Moffitt Cancer Center.

More than 50,000 Tampa Bay residents currently belong to AARP Medicare Advantage plans. (AARP Medicare supplement policies, drug plans and UnitedHealthcare commercial plans are unaffected by these changes.)

UnitedHealthcare is shrinking AARP networks and focusing on doctors, hospitals and clinics that will “enhance health plan quality, improve health care outcomes and curb the growth in health care costs,” spokeswoman Jessica Pappas wrote Monday in an emailed response to the Times. Hospitals and doctors that “demonstrate the highest quality at the greatest value will be rewarded for their efforts.”

Pappas could not say how many doctors will be dropped from the network or how many patients are affected. That analysis “is ongoing,” she wrote. About 19,200 Florida providers will remain in the network.

Medicare Advantage plans receive a monthly stipend from the federal government to manage members’ health needs. The plans create networks of providers and negotiate payment rates. Joining an Advantage plan can be cheaper for patients who remain in network than staying on traditional Medicare. But leaving the network means higher rates.

Some jockeying over networks and payments occurs every fall during open enrollment, which ends Dec. 7.

Read the entire entire Tampa Bay Times article here.

2 thoughts on “UnitedHealthcare Medicare Advantage practices in Florida raise eyebrows in Illinois.

  1. It’s not just in Florida. Here’s an article from a few days ago reporting that the same thing is happening in Rhode Island:

    http://www.providencejournal.com/breaking-news/content/20131021-unitedhealthcare-dropping-r.i.-doctors-from-medicare-advantage-network-poll.ece

    A week or so ago, they also dismissed a large number of providers in Connecticut:

    http://video.foxnews.com/v/2749230817001/unitedhealthcare-drops-medicare-advantage-doctors/

    http://courantblogs.com/ct-insurance/congressional-delegation-wants-answers-from-unitedhealthcare-after-cuts-to-doctor-network/

    And doctors are also dropping UHC because they are slow to pay and put up numerous barriers for patients:

    http://fpfairfax.com/United%20Health%20care.html

    In the above, reason #4 is particularly disturbing in that they have pre-approved procedures and then retroactively denied paying for them after they have been completed. That’s downright scary.

    To be honest, I’m a little worried about signing up with this outfit, in spite of what CMS might say. Covering out-of-network the same as in-network seems like it’s too good to be true and may only be possible (from UHC’s point of view) by cutting corners elsewhere, e.g. denying claims, not approving needed procedures, etc..

  2. That is scary indeed, even more so if one considers that United Healthcare is the ONLY ‘Medicare Advantage (PPO)’ provider choice for many retirees in many Illinois counties!
    It becomes quite clear then that the state wants those retirees to drop out of the subsidized plans and go privately insured to save money.

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