OSMA Asks CMS to Investigate UHC Physician Terminations

The Ohio State Medical Association (OSMA) has formally asked the Centers for Medicare & Medicaid Services (CMS) to investigate potential network adequacy issues in light of United Healthcare’s recent decision to terminate physicians from its Medicare Advantage plans.

The letter was written following a phone conversation between representatives from the OSMA and CMS which concluded with CMS inviting the OSMA to formally request the investigation and provide specific examples of potential standard network access problems. The OSMA has collected 18 such specific examples from its members as of last week and included each of those concerns in the letter to CMS.

The OSMA continues to dialogue with UHC leaders. The OSMA has expressed the same concerns to UHC and UHC leaders have confirmed to the OSMA that they are reviewing whether the selected terminations have in fact placed some patients at a severe disadvantage by losing the only quality health care available to them in proximity of where they live.

UHC does have a formal appeal process that physicians who have received termination letters can follow and UHC says that a few doctors have used the process and had their terminations from the plan reversed. UHC will not say how many Ohio doctors received termination letters or how many have been reinstated based on appeal. And many OSMA members have indicated that they were not satisfied with the level of attention their appeal may have received, which is why the OSMA then turned to CMS for a more thorough, independent review.

For continued updates on this issue, please continue to visit our website at www.osma.org and read OSMA This Week e-newsletter.

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