Categories: Health Care, Hospital, Patient Care, Physician Care,

In an unexpected decision, Medicare Advantage has begun dropping physicians from their insurance plans, weeding out doctors that it considers too expensive to cover, health insurance lawyers in Fort Lauderdale report. Along with the elimination of these physicians, insurance companies have begun to exclude doctors in commercial networks from their “narrower network” plans, which in turn excludes these doctors from participation in the state health insurance exchanges. Without these options, physicians across the country are being forced to evaluate how they will provide care for their patients while outside the traditional networks. 

Last fall, United Healthcare eliminated nearly 2,200 physicians nationwide from its coverage plans. Although these initial terminations have been stalled by temporary measures, including arbitration between the affected doctors and United, it is more than likely that these doctors will be dropped completely this year, and many others will soon follow. Some of the terminated doctors have been with United Medicare Advantage’s network for several years, and fear that they will lose a significant patient base once they are forced to leave. 

These decisions represent a shift in coverage and choices to “narrow networks,” as they have come to be known. Within these networks, insurance providers can eliminate any doctors they choose from their coverage, limiting physicians’ access to the state exchange plans. This has the added effect of cutting back on specialists that physicians can use for patients who need further care. If a specialist is no longer covered within the narrow network, patients of a particular physician with a working relationship to that specialist may suffer, as their doctor must now refer them to an unknown or untested covered specialist. 

Narrow network plans are mainly basing their decisions regarding who stays and who goes by cost, although cost is only one part of the spectrum when it comes to offering quality care. These limited networks have cropped up as a result of the 2013 Affordable Care Act (ACA), experts believe, and provide insurance companies with a way to remain competitive with the state insurance exchange plans. Insurers have also begun to cut back on their relationships with Medicare Advantage, mostly to comply with the government payment cuts mandated by the ACA.  

Doctors who have not yet been cut from Medicare Advantage’s plans may find increased pressure to cut costs in order to retain coverage, and this pressure may be jeopardizing the standards upheld by their practices. For specialists, costs are high due to special procedures, tests, and medications that are often necessary in high dosages, in order to effectively treat illness. If they are working under the threat of being dropped, doctors may be unable to avoid compromising their abilities and cutting corners at the risk of patient interest.  

At Lubell Rosen, we support doctors who want to continue to offer their patients the best, no matter how the insurance laws have changed. We represent doctors, nurses, and others in the medical field who practice in Florida, New York, New Jersey, and Georgia. For a consultation about your case, or inquiries into your legal rights and responsibilities under changing coverage and network plans, contact a health insurance lawyers at Lubell Rosen today.