United praised, and pressured to live up to its promise

In New Jersey, UnitedHealth Group gets flak for allegedly contradicting its claim to give physicians a freer hand. But in Texas, one group is lauding United.

By Bob Cook, amednews staff. Jan. 17, 2000.

The Medical Society of New Jersey is accusing UnitedHealth Group of not putting care back in the hands of doctors, as the company recently promised it would.

And yet in Texas, an independent practice association bought a full-page newspaper ad praising United for announcing it would let doctors order medical tests or procedures without prior authorization.

Both December actions are indicative of physicians' attempt to put pressure on the insurer and its rivals to live up to the Minneapolis-based company's Nov. 8, 1999, promise.

On Dec. 21, 1999, the Medical Society of New Jersey accused United of a "shift in policy concerning precertification of care." The statement came after one of its physician members, Pamela Klein, MD, who is a Westwood neurologist, complained to the society that radiological procedures and physical therapy were both still subject to precertification.

UnitedHealth Group medical director Archelle Georgiou, MD, responded that in "less than 10% of claim dollars" the company has contracts with a management-services organization or another party that requires precertification and the company can't suspend those deals immediately.

For example, a radiology management company has a contract with United covering New York, New Jersey, Connecticut and Ohio that requires precertification. The company is now trying to move out of that deal, she said.

Precertifications weren't the only target of the medical society's wrath.

The New Jersey society also said that on Dec. 1, 1999, UnitedHealthcare of New York-New Jersey sent a letter to members "demanding submission of all medical documentation" with level 4 and level 5 evaluation and management claims.

To Dr. Klein, this reeked of punishing physicians after delivering care, rather than denying it beforehand. She and the society were especially irked that United hired Columbia, Md.-based Magellan Specialty Health to, in the society's words, "process claims." Dr. Klein dropped her contract with another insurer a few years ago when it hired Magellan, noted for being tough -- or, in some physicians' minds, unreasonable -- on approving high-level claims.

"How are they going to recoup the money" lost as United gets rid of precertification? Dr. Klein asked. The answer: "Magellan [will] review my expenses and decide how much I'm worth."

"What I'll probably do is send my letter to United tomorrow ending the contract in 60 days," Dr. Klein said.

Dr. Georgiou said all payers, including HCFA, review claims to ensure their coding is accurate. Anyway, Magellan Specialty Health executive vice president Joe Farrell said the New Jersey society is wrong in saying his company will process United claims. He didn't elaborate on the nature of the relationship, but he did say Magellan has been hired by many payers simply to review claims.

"Determining accurate coding for claims is what we do," Farrell said.

Meanwhile, in Austin, Texas, an ob-gyn independent practice association seems to be having no problems with the "new" United.

Physicians for Women's Health, a 56-physician IPA, bought a full-page advertisement in the Dec. 12, 1999, Austin American-Statesman thanking UnitedHealth Group for its new approach regarding precertification.

"That was clearly good news for any physician to think that they were going to be able to practice medicine unimpeded by the bureaucracy of managed care," said Jeff Loomis, the IPA's executive director.

United has asked Loomis for permission to post his ad on its Internet site. When Loomis called to tell the company's Dallas public relations representative his group was placing an ad, the response from United was: "Negative?"

However, Physicians for Women's Health is interested in more than just publicly supporting United's change in precertification policy.

Loomis said he is hoping the ad prompts other health care plans to adopt United's strategy. He also said he hopes it will persuade other plans to join United in negotiating contracts with his year-old IPA, rather than going straight to individual physician members.