5,000 Medicare patients shut out from Austin Regional Clinic
Patients who are enrolled in UnitedHealthcare's Medicare Advantage plan were notified through mail by the insurance company last week that
"This was a sneak attack," he said. "We love United, but what they have done in this instance is really what we believe is extremely bad form because they're jeopardizing people's health care by introducing a lot of confusion and fear. Some of these patients have been with our doctors for 38 years, many over 30 years. For them to get letters saying as of
Clinic officials say UnitedHealthcare has reinstated
UnitedHealthcare officials dispute the clinic's claims, saying the clinic was not terminated from the network early and referred to the letters sent to patients that said patients need only to call the number on their insurance card to notify the company they wish to stay with
Control over patient claims
During contract negotiations,
This dispute does not affect non-Medicare patients, and the clinic will continue to accept commercial UnitedHealthcare plans.
"The reason ARC decided to leave UnitedHealthcare's network is not because they couldn't access patient claims. ARC has always had access to claims data for services that they render to their patients. ARC wanted to leverage a third-party organization's technology for processing patients' claims. UnitedHealthcare already has this capability locally in
The clinic receives claim reports from UnitedHealthcare six months after services have been delivered, which is too late, Chenven said. The clinic insists on using its own technology because its physicians don't want to have to use multiple platforms. Three other Medicare Advantage plans have agreed to use the clinic's technology, Chenven said.
"If you know all of what's happening to a patient ... and it's all in the claims ... and if you have sophisticated ability to analyze it, you can provide much better care," Chenven said.
Chenven said UnitedHealthcare's decision to prematurely move patients to another provider group has affected patients' access to prescription drugs, specialists and surgeries because their primary care physicians, who often write such referrals, are no longer considered in-network.
'It's truly scary'
Chenven said since last week,
"I'm being told what insurance I have to have and what doctor I have to go to. I have no right," Lemons said. "It's scary. It's truly scary. If I were to have an emergency who would I go to? I don't know this doctor, but most of all, she doesn't know me to what I need."
Clark said the Lemons have access to nearly 8,500 providers in
"In the meantime, we remain committed to working with ARC over the next few months to ensure members have seamless transition of care," Clark said.
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