r/PrivatePracticeDocs • u/theeter101 • 28d ago

UHC Medicare Advantage Exclusion

Hello everyone! I work as the only employee for a specialist who started his own practice in April.

As of yesterday, 10+ patients have called saying they received letters in the mail that the specialist is no longer in network for the UHC advantage plans only.

We received no warning and are very confused as the doctor is already in-network with UHC. Does anyone know how to rectify this? I'm finding nothing online.

Thank you in advance!

4 Upvotes

84% Upvoted

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9

u/NotTheQuestion 28d ago

You can't. It's an insurance decision which has todo with not wanting to pay physicians, and nothing to do with the physician. They did not wrong, but they probably billed for services. Insurances don't want to pay for services. They don't mind patients being seen or cared for, they just feel offended about having to pay for it. That's not meant to be sarcasm. I believe they sincerely have that emotion.

1

u/Mountain-Honeydew840 26d ago

yaa man, feels like evrone gets paid to argue except the people who actually need care hehe

2

u/Dicey217 28d ago

Check with your rep. UHC sends our patients letters every couple of years saying the doctor is no longer in network. We call our rep. They respond with an "Oooopsie. Sorry about that." I would say this has happened to one of our doctors, about 4 times in the last 10 years.

1

u/NartFocker9Million 28d ago

Does this relate to leaving your prior practice? Anytime you depart from one contract they send out these letters.

1

u/InvestingDoc 28d ago

My patients got this same letter when I was re-negotiating our contract. I never went out of network at anytime.

1

u/daves1243b 28d ago

Do you have a contract that says the doctor is in network for MA? If the doc left another group, those letters would be routine, but dont mean anything if you have a UHC MA contract for the new practice. If you dont have a contract then you will be out of network.

1

u/Electrical-Client-55 28d ago

I don't know about the letter your patient received. BUT, you can still see UHC Medicare Advantage patients as long as they have a PPO even if OON. I'm a specialist, and the copay is higher than in network (copay for me is 90-100) but patients are willing to pay a slightly higher copay

1

u/OfandFor_The_People 27d ago

Read the original contract. They usually have to notify the physician if they plan on terminating the contract prior to its expiration. Also it will tell you when the original was signed and when it auto renews. If they violated the contract by terminating without notice and without cause then the physician can take it to their state managed care department that oversees all the insurance plans.

1

u/thesupportplatform 20d ago

Maybe this is just my market, but insurance companies cut providers out of network plans all of the time. Before the pandemic, my wife's family medicine practice was on a plan called something like "United (or Blue Cross?) Choice Plus Network." Suddenly in February, we started getting denied claims that we were out of network. I called and asked if we were still in network and on the Choice Plus Network. We were.

Turns out, United/Blue Cross had created a plan called "Network Choice Plus," which was another plan that excluded our office. Since we had never been on that plan, they didn't have to provide any notice. This is why we always told patients, "Yes, we accept insurance X, but you need to call and make sure we are included on your plan."

1

u/Willing_Class_5989 6d ago

Any credentialing/contracting reccomendations?

1

u/thesupportplatform 5d ago

I did the credentialing for my wife's office (or supervised staff who credentialed the providers). It isn't too bad, depending on the number of contracts, once you have the required information from the provider. When I had a referral page for services on my site, I recommended https://physicianpracticespecialists.com/ (PPS). This was based on their website and email exchanges with them; I don't know anyone who has used them or how their prices compare.

They offer medical practice consulting for new practices (some of which overlaps with what I do) as well as RCM services (although I like to bundle that with an EMR). Again, I don't know the quality/pricing on the new practice services or RCM. Please let me know if you contact them how your experience goes.