UnitedHealthcare, one of Connecticut’s leading health insurance providers, has terminated the services of thousands of physicians providing Medicare Advantage (MA) plans. The insurer’s network change decision to terminate network physicians without cause will have a profound impact on both doctors and their patients. Doctors who have been treating Medicare patients for years will have to stop seeing them. Patients in a UnitedHealthcare MA plan who have had a comfortable, long-term relationship with their physician will no longer enjoy this privilege.
The insurer’s decision has affected both primary care doctors and specialists. UnitedHealthcare’s Medicare Advantage plans offer the same benefits as Original Medicare which includes the benefits of Medicare Part A, including hospital stays, skilled nursing care and home health care (but not hospice care). They also cover all the benefits of Medicare Part B, including doctor visits, outpatient care, screenings, shots and lab tests. Some plans include Medicare Part D prescription drug coverage and additional benefits such as routine hearing and vision care.
Physicians terminated by UnitedHealthcare need to take immediate action to ensure that they are reimbursed for services provided to patients before the end date. If they have outsourced their medical billing tasks, all they have to do is call up their medical billing company and ask them to follow-up on unpaid claims of patients enrolled in an MA plan issued by this insurance company. Professional medical billing services can ensure the following:
- Make sure the claims are sent in quickly and in time
- Evaluation of Accounts Receivable (AR) including old AR
- Follow-up to obtain the required information from the insurer
- Compiling of all unpaid claims
- Collecting of claim status – whether the claim is being processed or has been denied
- Calls to the insurer on speedy claim processing
- Aggressive action to follow-up denied claims including dedicated appeals processes
- Patient follow-up: calls to patients to get demographic details or missing information, and also collect outstanding patient dues
Doctors who are no longer in UnitedHealthcare’s network will have to inform their MA patients to seek another physician. Patients can do this by calling up the insurer and requesting a referral to another network physician. This is important because patient who need emergency care and see an out-o-network provider could end up footing the bill themselves.
Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.