By Theresa Agovino
Houston Chronicle
February 14, 2007
Doctors say UnitedHealth Group Inc. is threatening to fine them over something they can’t control: patients’ behavior.
Beginning March 1, UnitedHealth said it could fine a doctor $50 if a patient has tests done in facilities besides Laboratory Corp. of America or other labs that the company has selected. Doctors with patients who go out of network could also be subject to lower reimbursement and to exclusion from United’s network.
Last October, UnitedHealth announced that effective Jan. 1, 2007, its major national carrier would be Lab Corp. instead of Quest Diagnostics Inc. and began communicating with physicians about the switch. The fines don’t go into effect until next month to give both doctors and patients an opportunity to adjust to the change.
Some physicians say the size of the new network is too small.
The American Medical Association said this is the first time a doctor could be financially punished for a patient’s behavior. AMA trustee Dr. James Rohack said doctors can refer patients to in-network labs but patients may choose to go elsewhere because of convenience or preference.
Rohack remains skeptical about UnitedHealth’s pledge to work with doctors to avoid fines and other financial penalties. He said the current policy is more about saving UnitedHealth money than providing the best coverage for patients.
“They (United) always say they are going to play nice in the sandbox,” Rohack said. “But if the stock price starts to get shaky, they don’t place nice anymore.”
http://www.chron.com/disp/story.mpl/ap/fn/4554211.html
Comment:
By Don McCanne, MD
Except for single payer (Medicare for All), most of the leading proposals for reform would require individuals and/or employers to contract with this uncaring, wasteful, middleman insurance industry in order to gain access to health care.
Isn’t it long past time for us to take our health care system out of the insurers’ sandbox? How much sand in your face can you tolerate?