You may have seen the ad in the Tribune Chronicle a few weeks ago. It was placed to warn people of changes to United Health Care (UHC) AARP Medicare Advantage that will affect every citizen in Trumbull County.
United Health Care has arbitrarily dropped the majority of Trumbull County physicians from its provider panel. This corporate decision is enforced by a "termination without cause" provision in its contract with physicians. Contrary to United Healthcare statements, no new contracts were ever offered to any physician.
This move by UHC is paramount to Abandonment. By dropping so many doctors from its panel, UHC AARP Senior Medicare Advantage has worsened the "doctor shortage" in our area directly endangering you.
The rapidly changing medical environment is convoluted and confusing. Some simple facts demonstrated by this unprecedented move reveals the level of deception insurance companies will use in an effort to boost their bottom line.
First, by dropping almost all Trumbull County doctors, UHC wants out of the senior market in this area. With Medicare reimbursements falling and a retirement community such as we have in Warren, United Healthcare feels that they just don't make enough money on senior any more. This multi-billion dollar company will still collect your insurance premiums and the money it gets from government Medicare payments. But, instead of spending this money on your care, dropping your doctor allows UHC to keep all of the money by directly limiting access to your doctors and the care you need.
To do this, United Healthcare will trick you by telling you that you can "see remaining panel doctors." Unfortunately, there are only a very few "panel doctors" left in Warren. These limited offices will be overbooked, overworked and unable to handle the new influx of so many patients, making it virtually impossible for you to see a doctor.
UHC may also tell you a story they told one patient, about how his medical records were reviewed allowing them to match his medical needs with a panel doctor in Rocky River, 80 miles away. This deception is called "plausible deniability of care" a tactic insurance companies are now using to fatten their profit margins. In this health care model, the company doesn't deny you seeing a doctor, there just isn't one available or in your area.
Second, United Health Care will cleverly tell patients that they can "go out of network." When a patient goes out of network the insurance company pays the doctor 20-30 percent less, you pay the difference to the doctor but your monthly insurance premiums remain the same. This trick is immediate and pure profit to insurance companies.
To further confuse you, United Healthcare is telling some patients that they "cannot go out of network and have costs covered." This new approach was discovered by a patient of mine who asked United if he could continue to see his doctors who weren't going to be on the panel after Jan. 1, 2014. UHC told him they would not cover any costs.
In an emergency situation, this means you will be "stuck with the entire bill" as most doctors at Trumbull County hospitals are now off of United Healthcares' panel of physicians. This is extremely dangerous. Because of UHC decision, there may be no doctors available to see you in the E.R., requiring you to be shipped out of the area. If doctors do see you emergently, you will be billed for the full treatment amount.
Third, we have all heard the saying "buyer beware." Interestingly, the AARP "endorsement" in the United Healthcare AARP Medicare Advantage product is not an endorsement at all. It comes because UHC bought the rights from AARP to use their name, When I talked to AARP, the representative stated that they do not endorse any of the products on their website. AARP did not give United Health Care its "seal of approval" at all, it was bought by United Health Care with millions of dollars to trick seniors.
Finally, patients calling United Healthcare seeking additional information have been told the doctors did not want to be on United Health Care panels and would not sing a contract with the company. Additionally, United Health Care has been calling patients and telling them that the doctors did not want to be on the panel and would not sign a contract. As mentioned above, we want patients to know: this is a lie. No contracts were ever offered to any physicians dropped from United Health Care.
When I asked Dr. Grajdowski, a representative with United Health Care, to stop these lies he told me he couldn't help me and hung up the phone. Also, United Health Care, in response to letters sent to them from my patients has threatened to use the legal power of Medicare to stop this information from getting out. A Miss Hill from UHC sent me a wonderfully colored threatening letter to this issue.
While all "dispaneled" doctors have been working day and night to inform United Health Care of this disastrous decision, the decision will not be changed. United Healthcare has even violated its own appeals timeframe requirement and is not allowing physicians to present the impact of this devastating decision to any UHC review board.
The termination is now final. As of this week, United has been sending letters to patients telling them to select new doctors.
The reader may be stunned and asking himself if this is really true. Sadly, my colleagues and I can honestly attest to each of these facts.
The medical community realizes that all citizens of Trumbull County must be informed of this situation. United Healthcare enrollees must make intelligent decisions to protect themselves from the terrible consequences these action by UHC will cause.
Your doctors in Trumbull County believe that for your safety, all United Healthcare AARP Medicare Advantage patients need to switch coverage to another carrier. There has never been a more important time than now to look at other health insurers. Many health insurance options are available. Most doctors' offices and insurance agents are offering assistance to patients in choosing a different insurance company and dropping Untied Healthcare AARP Medicare Advantage. The sign up date for changes to Medicare coverage needs to be completed Dec. 7, as reported in this newspaper last week. Don't let that date go by without a change. You need to change now.
The outpouring of support we physicians have received concerning this matter is truly astounding and greatly appreciated. Our patients are dumbfounded and stunned by the decisions, lies and deceptions United Healthcare is perpetrating.
Hopefully, this letter helps you understand United Healthcare's unprecedented abandonment of Trumbull County patients, the deceptive actions it is taking to cover this up and the disastrous effect it will have on you. This change will affect all patients in Trumbull County as the number of docs available to treat patients has now been made arbitrarily smaller because of these irresponsible steps.
Realize the doctors are fighting to help you, but most importantly, realize that you need to help yourself. The time to change health insurance carriers is now. Call your doctor's office or insurance agent for any questions and help you need. United Healthcare enrollees, prepare yourself for the changes that are coming Jan. 1, 2014. They will affect you.
The authors practice in Trumbull County.