UHC Making It Impossible to Determine FL Provider Network

[yogooglethis]

Anybody else finding it extremely frustrating trying to determine which providers are actually going to be participating in the Florida RPPO plan for 2014?

"Optimization" is the euphemism UHC is using for cost cutting plan of slicing and slashing of the provider network just before the start of the AEP . No official communications is given to agents about something so important to existing and potential new business ahead of time and we only learned about it after all the certification and contracting was completed and then we have to learn about it from angry clients who call us after they received letters informing them of UHC's plan to drop their provider or providers from the network in 2014.

I wasn't happy about that but now I am having a very hard time determining which providers will actually still be in the network in 2014.

There will be no printed directories available to agents so the best thing available is the PDF copy of directory that can be downloaded from agent portal. .The problem is getting correct information about what the footnotes in the PDF copy of the 2014 provider directory is actually suppose to signify and if that information itself is accurate. These are the footnotes for provider status being used in the downloaded directory:

1 (Closed to new enrollments)
2 (Accepting existing patients only)

Sounds easy enough but the problem is I can't get a straight answer from my upline or PHD as to what ( Closed to new enrollments) indicates .Does it mean the provider is closed for new enrollments for the rest of 2013 and their contract terminates 12/31/2013 ? Or does it mean that they are not taking any new patients existing or otherwise but the patients that are currently seeing the provider will continue to be able use the provider in 2014 as a participating provider.?


In the online searches for PCP's they use "Closed" and " Existing" as well but it doesn't always reflect what the 2014 directory says.For specialist you have to click on " more info " tab to get any additional info on the contracting status and if you want to continue searching you have to wait for the " more info " page close which it never does so you have to close out the search and restart the process in a new window.

So you can call the doctors office to find out right? Wrong.Some of these doctors don't know their contract is being terminated and of course there is always the problem of flaky office staff giving out wrong information.

Today as I was preparing to call one of my clients to review their 2014 UHC benefits I spent about 15 minutes of intense searching using all the tools provided to me by UHC to determine whether my clients Cardiologist was actually still in the network and after all the detective work I still didn't feel confident that I really new the correct information before I called her.I have found myself in this dilemma quite a few times since 10/1 when trying to reach out to my UHC clients and prospects.

It is really going to be challenging out in the field this AEP trying to determine which providers are actually in the FL UHC RPPO or any of the plans for that matter

 

[moonlightandmargaritas]

It is really going to be challenging out in the field this AEP trying to determine which providers are actually in the FL UHC RPPO or any of the plans for that matter

They don't care.

I have two 15+ year friends who work in the UHG home offfice in Minnetonka, Minnesota. This AEP is all about profitability (although they won't admit it).

 

[yogooglethis]

They don't care.

I have two 15+ year friends who work in the UHG home offfice in Minnetonka, Minnesota. This AEP is all about profitability (although they won't admit it).

I don't think it's a secret to Wall Street. Article in aishealth.com Medicare Advantage News July 2013

Says by 2016 they will be operating more clinic model type HMO's like Humana to be able get some of that extra 5 star rating cash money .Then they can give free rides in limos to PCP office!

United Stresses Protecting MA Margins in 2014 via Exits, Benefit Cuts
UnitedHealth Group told Wall Street on July 18 what the financial community wanted to hear: ...

 

[policy doctor]

Interesting you posted this. I just had a client call me Friday because their dr office cancelled an app't scheduled for this coming week. Reason...United was not paying them and no longer in network.

Told her to call the co. Have the co find her a referral. They will be subject to SAR this AEP and I may switch them to another co although there is CIP. Very little difference between the HMO and the CIP-RPPO far as copays except for MOOP. Starting to have reservations about it though.

On the agent's portal you cannot access the directory. On I-enroll I do not see CIP loaded for 2014 neither is their web-site ready. Not loaded on B-connect either. As the mgr said...they don't want any business this year except med supps. And there is no advertising for mapd's except med supp. (Sigh)

 

[sman]

Interesting you posted this. I just had a client call me Friday because their dr office cancelled an app't scheduled for this coming week. Reason...United was not paying them and no longer in network. Told her to call the co. Have the co find her a referral. They will be subject to SAR this AEP and I may switch them to another co although there is CIP. Very little difference between the HMO and the CIP-RPPO far as copays except for MOOP. Starting to have reservations about it though. On the agent's portal you cannot access the directory. On I-enroll I do not see CIP loaded for 2014 neither is their web-site ready. Not loaded on B-connect either. As the mgr said...they don't want any business this year except med supps. And there is no advertising for mapd's except med supp. (Sigh)

And for 2014 the outpatient surgery copay for CIP is 20%. Just like UHC. I really don't want to have to replace all the CIP I wrote last year.

 

[Agentinjax]

I'm glad you posted this. I have written a lot of business with United this year and was looking forward to some great renewal checks in a few months NOT!! It is my understanding that profitability is the bottomline and the reason behind the service area reductions.

In my county alone, they termed around 300 doctors. Agents were not told which doctors and many doctors don't know. This is crazy.

I saw one of the letters my client received and it had about 10 specialists that she has seen while being with United listed as well as her PCP.

Some of the Providers are already termed with a 10/1 effective. I found out while trying to enroll a new member. I couldn't find the doctor listed online anymore. I talked to agent support and was advised "if the PCP is not found in their system, he is no longer in-network"!! So, if I would have just enrolled that person and went by what was listed in the old printed directory, they would have just changed the PCP to someone in network and when she tried to go see the PCP she wanted, she would have been charged an out-of-network co-pay of $45 instead of the usual $0!! SMDH.

If you find out how we can find out who has been termed or is being termed, let us know and I will do same.

Most of my clients are not changing PCP's and from the looks of things, it seems to be more cuts on the specialists side than the PCP side. My clients might change specialists but, not PCP's so I will get a ton of chargebacks when they jump ship to a plan that their PCP does take and that sux!

 

[Mink]

Agents need to know that UNH does not care. Especially about agents.

 

[policy doctor]

And for 2014 the outpatient surgery copay for CIP is 20%. Just like UHC. I really don't want to have to replace all the CIP I wrote last year.

I couldn't handle it unless people came to me. And i'm fearful of what changes may occur for 2015 with CIP....their star rating is not so hot considering 97% client satisfaction so they better improve it.

Guess I better spread the clients around.

 

[MedSuppPro]

... i'm fearful of what changes may occur for 2015 with CIP...

Doesn't CMS require after two years that all merged or purchased plans morph or become one with the parent company?

In other-words; Coventry (First Health) becomes Aetna and CIP becomes UHC for 2015.

 

[Russ]

I've gotten calls from 2 customers with UHC MAPD PPO(NW Florida), where the doctor is no longer in-network. As I'm panicking to find a replacement company that has the provider "in-network" and get certified....Humana comes to mind. Doctor is not listed in-network with Humana on one source. In-network on another Humana source. Real professional Humana.

Problem is...you have to take that stinking class to write their MAPD's. Call the closest office(Pensacola),....no classes given anytime soon. They just gave one last week. Called the Jacksonville,FL. office....no classes given anytime soon. They just gave one last week.

Basically I'm screwed. And the AEP hasn't even started yet!

And thanks UHC for NO provider directories. Sure am glad I quickly recertified with them in August and didn't find out about the providers until 6 days ago, at most. The agent is a grain of sand.