Federal Appeals Court Slows Insurer's Intent to Trim Physician Network

AAFP, Connecticut AFP Show Support

February 18, 2014 04:45 pm Sheri Porter

On Friday, Feb. 7, medical associations and physician groups in Connecticut applauded the decision of a federal appeals court that effectively halted -- at least temporarily -- efforts by UnitedHealthcare (UHC) to trim thousands of Connecticut physicians from its Medicare Advantage plan network.

[Cracked cement symbolizing a broken contract]

The decision issued by the 2nd U.S. Circuit Court of Appeals in New York upheld an injunction granted by the federal court in Bridgeport, Conn., and gave affected physicians until March 7 to challenge their removal from the UHC network by filing arbitration proceedings.

Sen. Richard Blumenthal, D-Conn., issued a Feb. 7 press release(www.blumenthal.senate.gov) that called the decision "a victory for both health care and justice -- patients and doctors."

"The Second Circuit's decision protects patients and providers by prohibiting UnitedHealth Group from prematurely purging thousands of providers from its networks without adequate notice to patients … the insurer's actions have very real and detrimental effects on patients."

The AAFP, the Connecticut AFP and the Connecticut State Medical Society were three of the 35 medical associations and physician advocacy groups that joined in "amicus curiae" briefs filed late in December to support the plaintiffs -- the Fairfield County Medical Association and the Hartford County Medical Association.

The Latin term amicus curiae translates as "friend of the court"; groups that join an amicus brief are not part of the legal suit but have important knowledge that can be offered to assist and advise the court on a legal matter.

Mark Schuman, EVP of the Connecticut AFP, explained to AAFP News why the Connecticut chapter took action. "We felt strongly that UnitedHealthcare should be held accountable for its clear lack of concern with the quality and continuity of care for its members; the actions of this insurer could significantly damage the physician-patient relationship," he said.

"Patients deserve to know if their physicians will still be there to care for them and patients need assurances that they will continue to receive adequate access to care," Schuman added.

In an interview in November, UHC Vice President of Communications Terence O'Hara told AAFP News that the insurer was cutting its physician networks in several states to encourage high-quality health care coverage at an affordable price.

He said the network changes "were necessary to meet rising quality standards, slow the increase in health costs and sustain our plans in an era of Medicare Advantage funding cuts."

Physicians in other affected states will be closely watching the outcome in Connecticut.