Doctors dropped from private Medicare plans

Contract terminations could affect hundreds of patients

ENGLEWOOD — Doc Hutton doesn’t know what he’ll do after finding out from his doctor, Pedro Casanova, that he will be unable to accept United Healthcare’s Medicare Advantage.

Casanova and a number of other Englewood doctors have received notice from UHC their contracts are being terminated. The letter Casanova received, dated July 29, states: “Given the significant changes and pressures in the health care environment, we have undertaken a review of our network and are making changes to its composition.

“As a result, United Healthcare is amending your agreement reference above to discontinue your participation in the Medicare Advantage network effective Jan. 1, 2014.”

According to medicare rights.org, the difference between Medicare and Medicare Advantage is while Medicare is provided by the federal government, Medicare Advantage plans are sold by private insurance companies that provide Medicare benefits.

“None of the patients I know of have received any notice,” said Ruby Sipper, office manager for Casanova. “They’re hearing about it from us.”

Hutton’s been a member of UHC for three years and a patient of Casanova’s for eight.

“I’ve had real good service (from my provider),” he said. “It’s been reasonable. I don’t want to switch providers. I like my doctor and provider. I don’t know what’s going on. I haven’t heard anything from United at all. I’m very good and concerned about my health insurance since it affects several of my doctors.”

Sipper said they received the letter as per the contract they have with United giving them 90 days’ notice. Sipper said UHC’s actions may have to do with the Affordable Healthcare Act, often called Obamacare.

“A lot of the providers aren’t really helpful,” she said. “The United Healthcare program policies are in part from AARP. It’s funny how much AARP is telling us how important Obamacare is, then they drop us like that. What’s wrong with this picture?”

Sipper said most of Casanova’s patients are old enough and eligible for Medicare.

“We have plenty of plans, and the United Healthcare plan has been beneficial for many of our patients,” she said.

Casanova said he’s waiting to hear feedback from patients to determine his next course of action.

“I wanted to see how they feel and what is available to them,” he said. “About 10 percent of my patients are with United Healthcare. They want to stay with this office. I don’t think it’s fair that patients aren’t being informed. I think that’s the elephant in the room to say it has anything to do with Obamacare.”

Eric Pressman, a doctor at Cardiology Center of Englewood and former chief of medicine at Englewood Community Hospital, worked with UHC for four years and his partner, Dr. Kenneth Pfahler, for 10.

“The assumption is United Healthcare was attempting to narrow their spectrum of providers, thus eliminating Englewood (policies),” Pressman said. Pressman said United is eliminating coverage from independent practices or small group providers from Englewood.

“They’re not touching larger groups that I know of yet,” he said. “Without our practice alone, over 660 patients are affected. We’re predominantly an elderly community and they’re too weak or debilitated to travel. What it can do is flood emergency rooms and increase cost to society. This diminishes quality of cardiology care for the community.”

Pressman said they’re seeking counsel and encouraging his patients to write to UHC.

According to Susan Rachles, director of marketing at ECH, the hospital is still participating with United Medicare Advantage products.

“To help meet the evolving needs of health care consumers, United Healthcare will, at times, adjust the size and composition of its physician network,” said Kim Whitaker, a spokeswoman with UHC. “United Healthcare notifies plan members of any physician network changes and helps members transition to new providers, as appropriate.”

Whitaker said members enrolled in UHC’s commercial (plans), Medicaid, Florida Healthy Kids and Medicare supplement plans are not impacted by current changes to the Medicare Advantage network in Florida.

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About Tom

Tom Chang is a freelance journalist with a background in multimedia journalism and web publishing. He is currently pursuing his Masters in Journalism and Media Studies from the University of South Florida St.Petersburg. He graduated in 2004 with a Bachelors Degree in Mass Communications at USF Tampa. Tom's interests include a little bit of everything from entertainment to sports. He also wishes to delve into creative writing writing sci-fi/fantasy stories. Tom was recently the Online Editor for USF St. Petersburg's the Crow's Nest, he joined the staff in January 2010 where he started freelance writing, photographing, copy editing and later became a staff writer. Tom’s freelance experience in journalism amassed a wide range of companies including Creative Loafing, The Focus Magazine, Lutz News, Examiner.com, and Tampa Tribune.
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3 Responses to Doctors dropped from private Medicare plans

  1. Blueyes says:

    My office got this letter also. So annoying and I believe it’s not all medicare advantage plans yet.

  2. Linda James-Smith says:

    Beginning Jan. 1, 2014, Nevada Heart & Vascular Center will no longer accept Medicare Advantage. Still trying to decide what to do.

  3. Gatorboy says:

    My clinic was cancelled that I have used for 10+ years and now am having to shop around for another plan. Thanks to ObamaCare I guess that this is due to $781 Billion being diverted from Medicare to ObamaCare to pay for the subsidies under the new programs. This is very upsetting and I think congress and the current administration are to blame and it will costs us all more in fees and insurance payments.

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