Skip to main content

Docs say insurers dropping them in hopes their costly patients follow

By Chris Frates, CNN Investigative Correspondent
updated 10:39 AM EST, Thu December 19, 2013
STORY HIGHLIGHTS
  • Ohio doctor is one of many being dropped by insurance companies, AMA says
  • Medicare cuts in Obamacare are changing provider networks, industry spokesman says
  • Ohio couple opted for a more expensive insurance plan to keep their doctor

(CNN) -- When Jody Sabatino opened her mailbox last month, she got some jaw-dropping news: Her insurance company, UnitedHealthcare, was cutting the 79-year-old's most trusted doctor from its Medicare Advantage plan. In fact, four of her six regular doctors won't be covered at all next year.

"I couldn't believe it. I just couldn't believe it," Sabatino said.

What's easier to believe for those affected by the cuts is that because Obamacare makes it harder for insurers to cut patients from their rolls, they're cutting doctors instead -- and hoping patients follow them off the plan.

United's move left Sabatino and her 94-year-old husband, Nick, facing a tough choice: Do they stay with United and find new doctors or try to keep their doctors by finding a new insurance plan?

"Dr. Mieczkowski has been my doctor for 20 years. No one knows me any better than he does, and it's silly not to continue to go with him," Sabatino said.

So she went shopping. And the insurance plan she bought is going to cost her more. Of the eight prescriptions that United covered, half of them are either going to cost more or aren't covered at all under her new plan.

Insurers ease deadline to pay for Obamacare policies

First lady tapped to sell Obamacare
Microsoft exec to oversee Healthcare.gov
Is Obama's "lie of the year" a GOP win?

But by switching plans, Jody Sabatino gets to keep Dr. Lawrence Mieczkowski, or "Dr. Mitch." The cardiometabolic specialist will be unceremoniously dumped from United's Medicare Advantage network next year with little explanation.

"Given the significant changes and pressures in the health care environment, we have undertaken a review of our network and are making changes to its composition," United wrote to Mieczkowski in an August letter. "As a result, UnitedHealthcare is amending your agreement referenced above to discontinue your participation in the Medicare Advantage network effective on January 1, 2014. ... This amendment does not require your signature."

But the doctor thinks United is trimming physicians from its networks in hopes that their patients will follow.

"Let those high-cost patients move out of the UnitedHealthcare Medicare Advantage plan over to Anthem or Humana and let those poor suckers, so to speak, pick up the cost," Mieczkowski said.

In Ohio, where Mieczkowski practices outside Dayton, hundreds of doctors and thousands of patients have been affected by United's cuts. And in Connecticut, United cut about 20% of its doctors, according to the state medical society. The American Medical Association says United and other insurers have taken similar action in at least a dozen states.

"The patient costs a lot," said Todd Baker of the Ohio State Medical Association. "And United is going to those patients' doctors and dropping them and therefore getting rid of the patient."

United concedes it is reducing the size of its Medicare Advantage network, saying it will shrink by about 10% to 15% by the end of next year.

"Many health plans are making changes to their networks to improve quality and keep health insurance affordable," United said in a statement to CNN. "These changes are necessary to meet rising quality standards in an era of Medicare funding cuts, and will improve our ability to work closely with physicians and encourage better health outcomes for our members."

The insurance industry's trade group argues that the changes are a direct result of Obamacare. To help pay for health care reform, lawmakers included $200 billion in cuts to the Medicare Advantage program and a new tax on health insurers.

"Washington can't cut and tax the Medicare Advantage program this much and not expect seniors in the program to be harmed. And that's exactly what we're starting to see," said Robert Zirkelbach of America's Health Insurance Plans. "This is just the beginning. As more and more of these cuts go into effect over the next several years, seniors are going to face even higher premiums, higher out-of-pocket costs for services and fewer health care choices."

And even though Sabatino was able to find a plan that allows her to continue to see Mieczkowski, she will still lose two other specialists.

"We're walking away from people that we've known and trusted and counted on for over 10 years, and that's hard," she said. "That's hard."

Christie on Obamacare ad: Get out of your PJs

Private exchanges: Obamacare signup process still not ready

Microsoft exec to oversee Obamacare website

Sebelius orders review of Obamacare website

ADVERTISEMENT
Part of complete coverage on
updated 1:35 PM EST, Fri November 21, 2014
House Speaker John Boehner said he has sued the Obama Administration in federal court over its decisions to make changes to the President's health care law.
updated 3:00 PM EST, Tue November 11, 2014
Two potential 2016 Republican presidential candidates -- Rep. Paul Ryan and Sen. Marco Rubio -- are teaming up on a proposal to replace Obamacare.
updated 9:24 PM EDT, Sun October 12, 2014
Tthe Department of Health and Human Services has released a report highlighting the impact of the law on hospital costs.
updated 11:05 AM EDT, Wed July 23, 2014
Two U.S. appeals courts issued conflicting rulings on a subject that's important to millions of people: the availability of subsidies to help purchase coverage.
updated 10:06 AM EDT, Wed July 23, 2014
It was a tale of two rulings -- the best of times and the worst of times for Obamacare in the federal appeals courts.
updated 6:00 AM EDT, Wed July 23, 2014
More than half the public says Obamacare has helped, but less than one in five say they've personally benefited from the health care law.
updated 8:01 AM EDT, Fri July 11, 2014
House Republicans are going forward with plans to sue President Barack Obama and will base their legal case on the sweeping health care law he championed and they despise.
updated 6:41 PM EDT, Tue October 29, 2013
Nationally, consumers are learning a number of well-known hospitals won't accept insurance under Obamacare.
updated 1:16 PM EST, Mon December 23, 2013
Open enrollment started October 1. Here's a step-by-step guide to navigating the insurance marketplaces, also known as exchanges.
updated 4:37 AM EDT, Sat October 19, 2013
Obamacare has survived a Supreme Court appeal, a government shutdown and ongoing challenges by opposing politicians.
updated 10:44 AM EDT, Thu September 26, 2013
If you don't know what all those health insurance buzz-words like "co-pay" and "premium" mean, you're not alone.
It's a popular assertion, but is it true? The CNN Politics team hunts down the facts.
Some may offer help navigating the new health insurance marketplace for a fee. Others will warn that you will need a new Medicare card.
updated 12:57 PM EDT, Mon September 30, 2013
Who's in, who's out... and what about the costs? CNN Chief Medical Correspondent Dr. Sanjay Gupta breaks down Obamacare.
Consumers can avoid the exchanges by buying plans directly from insurers or through brokers. But should they?
Here's the first look at insurance premiums on 36 exchanges run by the federal government.
Check out our page with all things you need to know about Obamacare and how it will affect you.
ADVERTISEMENT