More on United Health Care Returning Decision-Making to Doctors
Special E-Mail Bulletin
Hi, everyone. Thought you'd find this newswire story interesting. Came up on the internet today in regard to United Health Care's announcement that it is returning decision-making to doctors. As you know from reading my recent e-mail bulletin I am a skeptic.
I can't comment on the validity or impact of the issues raised here, but it seems that there are other curmudgeons out there! :o)
Gil Weber
Medical Society of New Jersey Calls United Healthcare Policy a Sham; Physicians Denounce Shift in Policy
December 22, 1999
LAWRENCEVILLE, N.J., Dec. 21 /PRNewswire/ via NewsEdge Corporation -
The Medical Society of New Jersey today denounced United Healthcare's (NYSE: UNH) shift in policy concerning pre-certification of care. After initially stating that it will give doctors the final say on medically necessary care, United Healthcare has shifted its focus 360 degrees and will now review medical decisions after all. In a December 1 document entitled "Physicians Reference Guide," United Healthcare of New York/New Jersey says, "Claims will be adjudicated retrospectively, according to a five-step process."
"The perception was that United Healthcare was giving doctors greater freedom to decide what type of care their patients need," said Patricia Klein, MD, Medical Society of New Jersey. "They pretended to be acting in the best interests of patients and physicians, but have pulled the rug out from under them."
In November, United Healthcare -- the nation's second-largest health insurer -- announced that they would no longer require prior approval for medical tests and treatments. That meant doctors could schedule X-rays and outpatient surgery without seeking permission from the HMO. The position even received nationwide praise, including an endorsement from the American Medical News' editorial staff which stated in a December 20 editorial, "United's action confirms what doctors have been saying for years, that a policy of second-guessing physician treatment decisions is an inefficient way to run a health plan."
As of December 1, United is now demanding submission of all medical documentation with all Level 4 and Level 5 Evaluation & Management claims, including all office and outpatient services, consultations, and unlisted evaluation and management services. What's more, physicians must still receive pre-certification from United Healthcare for MRIs, CAT-Scans, physical therapy and other medical procedures. United Healthcare also announced that Magellan Specialty Health is processing its claims. This out-of-state corporate claims management firm has presented great difficulties to New Jersey physicians in the past and has been dropped by other HMO's in the state, such as Horizon BlueCross BlueShield.
"Last month, United sold pipe dreams and everyone bought a ticket," said Irving Ratner, MD, President, Medical Society of New Jersey. "It's time for patients and physicians to reevaluate United Healthcare's transparent promises, and see this shift in policy for what it's worth: another attempt by managed care to circumvent patients in favor of increased profits."
Founded in 1766, the Medical Society of New Jersey is a voluntary association of 9,500 physicians statewide, whose mission is improving the health of New Jerseyans and acting on behalf of its members in legislative and regulatory matters.
To speak with a Medical Society of New Jersey representative, or for a full copy of United Healthcare's Physician Reference Guide, contact Jon Hendl at 201-964-2372.
SOURCE Medical Society of New Jersey
CONTACT: Jon Hendl, jhendl - at - mww - dot -com, or Everett Merrill, emerrill - at - mww - dot - com, both of The MWW Group, 201-507-9500, fax, 609-896-1368, for Medical Society of New Jersey
Web site: http://www.msnj.org/ (UNH)