Corporate health insurers have many ways to cut costs, including only contracting with network providers willing to accept extremely low rates and restricting the number of specialists in their networks. In an opinion piece for the South Carolina paper, the Post and Courier, Eveline Wang MD, an endocrinologist, explains how UnitedHealthcare slashed her practice’s provider rates well below Medicare’s. In short, UnitedHealthcare forced Dr. Wang and her colleagues to end their network provider contracts, allowing UnitedHealthcare to cut costs while jeopardizing access to specialty care for enrollees relying on these providers.
Because of its leverage, Medicare is able to negotiate low rates with physicians, hospitals and other health care providers. Medicare’s rates tend to be significantly lower than corporate health insurance rates. UnitedHealthcare proposed to pay endocrinologists in Dr. Wang’s practice rates that were well below Medicare’s and well below their cost of delivering care.
Dr. Wang treats people with complicated diseases, including diabetes. There’s a shortage of endocrinologists in the US. People wait long stretches to see an endocrinologist. Cutting endocrinologist rates in Dr. Wang’s area significantly below Medicare’s rates and effectively forcing these providers to end network contracts could mean leaving many of their patients to die.
What was UnitedHealthcare thinking and how is it allowed to set provider rates that are inappropriately low? Physicians cannot be expected to accept a payment rate below their costs. For sure, UnitedHealthcare saves money by slashing provider rates and by pushing physicians who see patients with complex conditions out of network. But, to protect patients, these insurer tactics should not be allowed.
Here’s more from Just Care:
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
- Seven reasons commercial insurance cannot meet our health care needs
- OIG finds widespread inappropriate care denials in Medicare Advantage
- Whistleblowers expose fraudulent Medicare Advantage billing practices
- UnitedHealth could force nearly 3,000 patients to forgo care or find new physicians
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