Doctors jockey for place in plan

doctors meeting

Hundreds of people in the Mahoning Valley can no longer go to their trusted doctors, and local officials say the Affordable Care Act is to blame.

Doctors from the Mahoning County Medical Association sat down with US Representative Bill Johnson in Canfield Tuesday to discuss their concerns with UnitedHealthcare’s decision to drop local doctors, including the Eye Care Associates practice in Beaver Township, from their Medicare Advantage plans. That means patients either have to change doctors or pay out of their own pockets.

“Now they are facing the choice of switching to another doctor. They are really scared, really scared,” said Dr. H.S. Wang, Eye Care Associates, Beaver Township.

Dr. Sean McGrath, president of the Mahoning County Medical Society, said UnitedHealthcare made similar changes once before, knocking one of the area’s primary urology groups off the Medicare Advantage network. This makes costs higher and care worse for patients.

“It has done so by creating a significant geographic void of covered physicians that requires patients to travel further to receive their care,” said McGrath.

United HealthCare Spokesperson Kevin Shermach said many factors determine what providers will be included in a plan.

“There are multiple factors involved. Overall, our decisions are locally driven, based on a combination of geography, quality and efficiency: ensuring ready access to care, considering relative performance on industry quality metrics and a provider’s ability to deliver high quality care for the most members in the most cost efficient manner,” said Shermach. “Specific factors can include the relative breadth of our network in a particular market, the number of patients who are covered by our Medicare Advantage plan and the type of contract we have with that doctor.

When UnitedHealthcare dropped the urology group, Rep. Bill Johnson, R-Marietta, got involved, meeting with the insurance carrier and working with them to add the doctors back on the network. That’s not possible in every case, especially now when anywhere from 200 to 300 of Mahoning County’s doctors are being hit by cuts insurance companies are making due to the Affordable Care Act.

“It goes back to the broken promises of the administration. They promised under the ACA that if you like your insurance plan, you could keep it. If you like the physician, you could keep it, and we are finding that neither of those things is true,” said Johnson.

Shermach said UnitedHealthcare Medicare Advantage plan members have access to approximately 4,800 primary care physicians and more than 8,400 specialists across Ohio. Members with questions about their physician’s network status can contact Customer Care at 1-888-332-8883.

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