United Healthcare Medicare Advantage Network Terminations

Suggestions for Appeals and Communicating with Patients

Appeals

  • Be sure to review your own contract carefully, in addition to completing the appeals application attached to your termination letter, to see if you have any additional appeals rights.
  • According to UHC officials, appeals must be applied for within 30 days of the date on the letter you received. UHC will respond within 30 days.
  • UHC has indicated the termination is based on three principles:
    • Panel size (e.g. a larger panel size keeps physicians in the network)
    • Geographic access (e.g. limited availability of a specialty keeps physicians in the network in that region)
    • Current relationship with UHC (If they are in an ACO contract, they would remain in the network)

Be sure to provide information that addresses these concerns. For example, indicate if you are currently part of an ACO that contracts with UHC, provide the number and types of patients you are caring for that need continued care or evidence access is a concern. 

Communicating with Patients

  • Patients impacted will receive a letter from UHC. Inform your patients you will no longer be part of the UHC Medicare Advantage network, as of September 1, 2014. Tell your patients that this was not your decision but unilaterally a decision made by UHC.
  • Inform your patients of the networks you are in, in case they want to voluntarily move to another payer. Patients also have the right to appeal the request from UHC to find another physician.
  • First and foremost: Ensure that your patients can access the best care possible.
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