Why Are Doctors Dropping UnitedHealthcare?

UnitedHealthcare is one of the largest health insurance providers in the United States, covering over 45 million members. However, in recent times, a growing number of physicians and medical practices are dropping UnitedHealthcare due to various issues with the insurer.

There are several key reasons why doctors are cutting ties with UnitedHealthcare and no longer accepting their insurance plans.

Prior Authorization Hassles

One of the biggest pain points for doctors is UnitedHealthcare’s prior authorization requirements for tests, procedures, and medications.

Prior authorization involves getting pre-approval from the insurance company before providing certain treatments and services to patients. This is meant to ensure the care is medically necessary and covered by the patient’s policy.

However, doctors complain that UnitedHealthcare’s prior authorization process is overly burdensome, requiring extensive paperwork and phone calls that delay patient care. Approvals can take days or weeks.

According to a survey by the American Medical Association, 94% of doctors say prior authorization leads to delays in necessary care. Nearly 30% of physicians spend over a week just obtaining prior authorizations from insurers.

This causes patient treatment plans to get interrupted and creates unnecessary administrative workload for provider staff. Many physicians believe UnitedHealthcare excessively denies or delays approval for even basic diagnostic tests and routine procedures that are clearly needed.

Low Reimbursement Rates

Doctors also cite UnitedHealthcare’s relatively low reimbursement rates as a key reason they are dropping the insurer.

Reimbursements from UnitedHealthcare for many services, visits, and procedures are considerably lower compared to other major insurance companies.

For instance, a 2021 study found UnitedHealthcare paid primary care doctors just 83% of the Medicare rate on average, compared to 89-95% by other insurers. Specialists get particularly low payments from UnitedHealth.

Such inadequate compensation makes it financially unsustainable for many physician practices to continue accepting UnitedHealthcare patients.

Low reimbursements also force doctors to cram more patient visits into a day to try to make up for the lost revenue, leading to rushed and lower quality care.

Unexpected Coverage Changes

Another frustration for physicians is unexpected coverage changes made by UnitedHealthcare without consulting providers.

For example, in 2022, UnitedHealthcare suddenly removed several common gastroenterology codes from reimbursement under many plans, meaning doctors could no longer bill or get paid for them.

Similarly, UnitedHealthcare recently announced it would no longer cover emergency room visits it deems “non-emergency” for millions of members. But doctors argue it’s not possible to always accurately diagnose emergencies immediately.

Such abrupt coverage reductions by UnitedHealthcare negatively impact physicians’ revenue and clinical autonomy. Doctors accuse the insurer of focusing solely on boosting profits rather than patient welfare.

Denials for Established Procedures

Physicians also complain about UnitedHealthcare denying coverage for mainstream procedures and treatments that are considered standard of care within the medical community. But the insurer deems them “experimental” or “medically unnecessary” against the doctor’s judgment.

For example, UnitedHealthcare lists several evidence-based pain treatment options like epidural injections as “not medically necessary”. Doctors must then wage lengthy appeals to get approval, even if they strongly believe the procedure is appropriate for that patient.

Having to constantly fight denials for commonly accepted practices increases administrative workload for physician staff and delays critical care for patients.

Micromanaging Patient Care

Many doctors feel UnitedHealthcare excessively interferes with their clinical decision making and professional autonomy through aggressive utilization management tactics.

For instance, if a hospital stay extends even slightly beyond the insurer’s rigid length-of-stay criteria, UnitedHealthcare pressures physicians to discharge the patient prematurely. However, doctors feel patients need more time to adequately recover and get medically fit for discharge.

UnitedHealthcare also restricts doctors’ ability to make care referrals freely based on their assessment of the patient’s needs. Excessive oversight over clinical practices is frustrating for physicians.

Difficulty Getting Paid Fairly

Doctors often complain about difficulties getting reimbursed fairly by UnitedHealthcare even for approved services.

Reimbursement claims get denied or delayed due to technical glitches and extensive documentation requirements. Physician practices then have to devote substantial staff time and effort toward rectifying claim issues and following up persistently to get paid.

Without adequate and timely reimbursement, it becomes challenging for medical providers to sustain their operations, especially smaller independent practices.

Lack of Support for Independent Physicians

Independent physicians argue that UnitedHealthcare’s policies overwhelmingly favor large health systems and put smaller practices at a disadvantage.

For instance, reimbursement rates for smaller independent practices are typically lower than large hospital-affiliated groups. Claim denials are also more frequent for independent doctors.

Moreover, UnitedHealthcare invests heavily in direct contracts with big health systems. This diverts patient volume away from independent and community doctors whose services become non-preferred and more expensive for patients.

The resulting loss of patients makes it difficult for independent physicians to survive on UnitedHealthcare’s network.

How Doctors Are Fighting Back

In response to the above concerns, a growing number of physicians are choosing to drop UnitedHealthcare and asking the insurer to remove them from their provider network.

Some steps doctors are taking include:

  • Formally notifying UnitedHealthcare that they will no longer participate in the insurer’s plans after their contract ends. This prevents automatic renewal.

  • Publicly posting signs in their clinic and websites informing patients they do not accept UnitedHealthcare insurance anymore.

  • Refusing to enter new contracts with UnitedHealthcare when existing ones expire.

  • Terminating active contracts with UnitedHealthcare if the option exists, despite financial penalties.

  • Rallying colleagues to collectively drop UnitedHealthcare plans. For instance, the Texas Medical Association called for unified physician action against UnitedHealthcare given its history of not negotiating fairly with doctors.

  • Lobbying state and federal lawmakers to restrict insurers’ utilization management practices that undermine doctors’ judgement and patient care quality.

  • Educating patients about how UnitedHealthcare’s policies negatively impact care and encouraging them to switch plans if possible.

  • Speaking out publicly and informing media about their issues with UnitedHealthcare to create awareness.

Impact on Patients

As more doctors refuse to work with UnitedHealthcare, it reduces plan options for people under UnitedHealthcare insurance and limits their choice of providers.

Patients of doctors dropping out may no longer be able to continue treatment if their physician is suddenly out of network. They may be forced to switch doctors or pay large out-of-network charges to continue seeing their current provider.

To avoid such disruptions, patients dependent on specific doctors may have to consider switching their health plan if possible during open enrollment periods.

UnitedHealthcare’s Response

UnitedHealthcare states that the doctors dropping out represent only a small percentage of their vast provider network and will not compromise access for members.

Regarding reimbursement rates, UnitedHealthcare claims they offer fair market-based compensation, but doctors expect unsustainably high payouts. UnitedHealthcare also says prior authorization improves quality and lowers costs for customers.

In August 2022, UnitedHealthcare announced it was reducing prior authorization requirements to ease administrative burden for providers following backlash. However, many doctors remain skeptical of the insurer’s promises and hesitant to stay in-network.

The tussle between doctors and UnitedHealthcare reflects the larger tensions between providers and payers in the American healthcare sphere. Patients are often caught in the middle of this systemic conflict.

However, as doctors leverage collective action, legal advocacy, and public pressure, insurers like UnitedHealthcare may have no choice but to shift their historically provider-unfriendly policies to retain participating physicians. Without doctors within their network, insurers cannot function.

Why are doctors dropping UnitedHealthcare?

FAQ

What is the controversy with UnitedHealthcare?

The families of two now-deceased former beneficiaries of UnitedHealth have filed a lawsuit against the health care giant, alleging it knowingly used a faulty artificial intelligence algorithm to deny elderly patients coverage for extended care deemed necessary by their doctors.

Why did UnitedHealthcare drop?

Health insurer stocks dropped after UnitedHealth Group warned of higher medical costs as older Americans start to catch up on surgeries they delayed during the Covid-19 pandemic. Shares of UnitedHealth, Humana, Elevance Health and CVS Health all declined.

Why do doctors not like Medicare Advantage plans?

While many physicians work within the Medicare Advantage networks with few problems, the plans do not come without issues. One of the primary challenges doctors face is referral and pre-authorization requirements that may impede a patient’s needed medical care.

Why do they keep pushing Medicare Advantage plans?

One explanation: The plans are often cheaper than paying for a Medicare supplement, sometimes referred to as Medigap. Another reason for the growth may be the significantly larger commissions the government pays to brokers selling Medicare Advantage plans.

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