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.
