Wednesday, February 21, 2007

Quest Diagnostics Counters with a Left Hook!

If this were a boxing match then United Healthcare just took one to the head. The verbal pummel came from the Quest Diagnostics Teterboro Business Unit a.k.a. H.Q. when it produced a flyer directed to doctors in New Jersey. The flyer is titled Unhappy About UnitedHealthcare’s Penalty Program? Subtitled Three Things You Can Do.

Within the opening paragraph the author of the letter makes reference to the issue of possible financial sanctions against doctors starting March 1, 2007. The author here makes a very important statement as quoted herein: “Through these financial intimidation tactics, United is interfering with your ability to make medical decisions on behalf of your patients.”

The letter continues by making three important bullet points answering Why This Issue Matters. Below I offer those three bullet points in highlight so as to not confuse them with my comments contained within the Quest Diagnostics text.

• United has, in effect, implemented administrative policies that may change the terms of your provider agreement and limit your ability to practice medicine as you see fit. What will be the next medical decision that will be removed from your discretion if United is successful in its action?

I would have to wonder if the person who wrote this has been reading old Snakes’ blog, since this is the type of point I have been attempting to make to the medical community for some time.

• The selection of what laboratory to use for PPO, POS and indemnity patients is one we believe physicians expect to have when they sign physician provider agreements that are not restricted to HMO closed network products. Would you have executed your provider agreement with United if you had known that your ability to recommend which providers your patients should see would be limited by the imposition of these penalties?

This type of practice is one which in the retail business is I believe known as “bait and switch” in which the customer is looked at and treated as a sucker. The vendor advertises one product and then sells you something you didn’t want or changes the terms of the contract when you aren’t looking.

In the carnival world this is known as the “carney” and the “rube.” In the instance of the relationship of United Healhtcare and a contracted doctor, the “carney” a.k.a. United Healthcare and the contracted doctor a.k.a. the “rube.” The only thing lacking here is that the cost of the dart is more than fifty cents.

I can’t imagine that too many doctors would like being treated as a “rube” but that is precisely what United Healthcare is doing. And the only way that doctors can do anything about it is to stand up to the “carney.”

• United has changed a PPO, POS and indemnity patient into an HMO patient when it comes to laboratory services. Patients and employers purchase, through higher premiums and coinsurance amounts, the right to access out of network providers, yet United’s Protocol (which does not distinguish between benefit types) eliminates that right through its threats to the physician who refer patients for laboratory testing services. Should United be able to eliminate benefits unilaterally through administrative protocols?

Indeed, “patients and employers purchase, through higher premiums and coinsurance amounts, the right to access out of network providers,” this is one of the key points about how United Healthcare has been acting in a seemingly criminal manner. It is why I have called upon the legal community to step up to the plate on this issue. It is why I have been calling upon medical associations to step up to the plate.

Quest Diagnostics has made suggestions to doctors in New Jersey about what action they can take personally if they are concerned about their rights as doctors affected by this issue.

Contact your NJ State Medical Society
Lawrence Downs, Director Public Health & Acting General Counsel
Phone: (609) 896-7166 x 258
Send e-mail to Lawrence Downs

Contact your state Insurance Commissioner:
Lee Barry, Assistant Commissioner
Phone: (609) 292-5316 x 50156
Send e-mail to Lee Barry

Call or write United/Oxford:
United Main phone: (732) 623-1000
United Network management: (800) 638-8075

Alan M. Muney, MD, MHA
Executive VP & Chief Medical Officer, Oxford Health Plans
48 Monroe Turnpike
Trumbull, Ct 06611

Snake Oil Sam
Snake Oil Sam Internet Media Publishing © 2007

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