Cardiologist: UnitedHeathcare failed to advise Yale-New Haven Hospital patients

Feb. 24--NEW HAVEN -- A cardiologist and an advocate for seniors said UnitedHealthcare did not advise patients that they only had a short window to transfer to traditional Medicare if they wanted to continue to be covered when using Yale-New Haven Hospital.

They also said patients reported to them that the agents they contacted either told them the issue was being worked out or they were unaware of the cancellation of coverage under the AARP Medicare Advantage insurance plans.

Dr. Steven Wolfson, a cardiologist and a member of the 1,200 practitioners in the Yale Medical Group which staffs Yale New Haven Hospital, said his patients "acted on insufficient information."

Enrollment decisions had to be made by Dec. 7, 2013, but the breakdown in negotiations between the Yale New Haven Health System and UnitedHealthcare over the Medicare Advantage programs occurred in February, after they had already enrolled.

UnitedHealthcare told Medicare Advantage patients in a letter dated Feb. 4 that Yale-New Haven Hospital would no longer be in their network as of April 1. But it also held out hope that a deal was still possible.

"If we reach an agreement with Yale New Haven Hospital, we will notify you," it reads.

Some patients reported receiving the information as late as Feb. 10, four days before they would have had to switch to traditional Medicare, which includes Yale-New Haven Hospital. UnitedHealthcare said it did manage to come to an agreement with the hospital on employer-based health plans.

Wolfson charged that UnitedHealthcare is "trying to tailor the demographics" by eliminating physicians from their network who serve the most expensive patients.

The cardiologist charged that UnitedHealthcare is not doing anything to help with the transfer of records or make sure the remaining physicians in the network can pick up the additional patients.

Maria Gordon-Shydlo, a spokesperson for UnitedHealthcare, did not respond to this criticism.

The Hartford and Fairfield county medical associations, when they went to court over their members being dropped, estimated that between 20,000 and 30,000 patients could be affected.

"This is disruptive to care. It's dangerous. There will be real harm," Wolfson predicted.

He said none of the remaining hospitals in the network, use Epic, which is the electronic record keeping software system used at Yale New Haven. He feared important information will be lost as documents are accessed on the website and printed out.

Gordon-Shydlo, in a email, said clients with Medicare Advantage plans "continue to have broad access to hospitals and physicians across Connecticut to meet their health care needs, and we will work with them to ensure access to those providers and support care transitions as appropriate."

Gordon Shydlo said after March 31 "members in active treatment may request to continue receiving care at in-network benefit levels subject to their plans' Continuity of Care requirements."

The UHC spokeswoman said "in the event of an emergency, members should go to the nearest hospital regardless of network affiliation. Emergency services will be covered as an in-network benefit regardless of the hospital's participation status in UnitedHealthcare's network."

She did not answer why clients were not advised of the rapidly approaching date to switch to traditional Medicare .

U.S. Sen. Richard Blumenthal, U.S. Sen. Chris Murphy and U.S. Rosa DeLauro, D-3rd, have written to the Center for Medicare and Medicaid Services, asking that it approve retroactive disenrollment for seniors not given clear information on when they had to switch plans.

Blumenthal is also pushing CMS on invoking quality of network standards that UnitedHealthcare has to uphold.

The hospitals that patients can continue to use after March 31 include: Milford Hospital, Midstate Medical Center in Meriden, Griffin Hospital in Derby, Bridgeport Hospital and St. Vincent's Hospital in Bridgeport. None of them are rated as Level 1 trauma centers, a distinction Yale holds with two other facilities in Connecticut, according to the American College of Surgeons.

"I have already had three tearful goodbyes from patients," Wolfson said. "These are my friends."

The Yale Medical Group was cut from the network at the end of January, part of more than 2,200 physicians statewide.

Gordon-Shydlo did not answer a question if patients with Medicare Advantage used doctors in the Yale Medical Group as part of emergency treatment, would those physician costs be covered?

The Hartford and Fairfield country medical associations won an injunction in their court challenge allowing individual physicians a short time to go to arbitration to have UnitedHealthcare reverse its decision.

Wolfson said the New Haven County Medical Association, which did not go to court, was notified later than the Hartford and Fairfield groups.

He said the contract is also different in that the Yale Medical Group covered its members as a group, rather than as individual participating physicians, which is the case in Hartford and Fairfield.

"There was no criteria for the terminations," he said. Wolfson said there was no connection to the quality of care afforded patients.

Smilow Cancer Hospital, which is part of Yale-New Haven Hospital, is also no longer in the network.

Carolyn Sires-Halaszynsk, who runs United Seniors for America in West Haven, said she made several calls on Feb. 13 to the hotline provided by UnitedHealthcare after seniors contacted her about the issue.

Sires-Halaszynsk said she reached four agents through the hotline, none of whom were familiar with the decision on Yale-New Haven Hospital.

"Through my numerous phone calls throughout the day, no one who worked for UnitedHealthcare and answered the phone, was aware of the contract negotiations with Yale New Haven Hospital," she said.

Using her tax ID number through her business, she was finally able to reach supervisors in Flordia who found a reference to the negotiations, but not to the letter.

"This is a debacle of epic proportions," Sires-Halasznsk said. She said if the seniors she represents understood the situation "all of them would have left" the Medicare Advantage plan. "This is a product that was bought. You have to give some warrantees."

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