I am a physician who was just thrown out of the United Health Care Advantage Plan. Forgive me If I sound a bit pompous or arrogant here; it is not my usual demeanor. I do not drive an expensive car and I do not adorn it with MD license plates. I drive to work in my Honda, well dressed but not in thousand-dollar suits. And I do not advertise my credentials, although I feel, to make my point I need to at this time.
President Obama, in 2009 you told the citizens or our country, during an American Medical Associations Conference, “If you like your doctor, you will be able to keep your doctor, period” .
About two weeks ago patients like Anne P came to my office upset, some in tears, distraught over why I would no longer be in their United Health Care (UHC) Advantage Program. "Had I dropped out of the plan without telling them," some asked. How would they find a new doctor they could trust, and in only two months time? And why would they have to find someone when they have known me for up to twenty years? What they did not know is that I had no idea I was no longer a part of their healthcare plan until the patients began to inform me. It was not I who quit them but their insurance company who tossed me out like a piece of trash.
My staff shot off an e-mail to the UHC representative and got this response:
“All I can advise is that these Drs [doctors] are being affected due to United making changes to the network composition to meet the future needs of our members. Our Physician contracts provide us the right to do so without any reason. Any further action should be followed according to the appeals process outlined in the letter.”
We wrote back: “This is not an answer, the contracted providers are being terminated from this network without cause. There needs to be a better response than inviting the MDs to appeal. Please provide an explanation.”
They responded: “I've provided you a reason as well as next steps should the Drs [doctors] choose. We are not contractually or legally required to provide you with a reason.”
I wondered why I was tossed out of UHC Advantage and not other cardiologists?
Ironically only a few days before I received a letter from one of the most senior physicians at UHC who had recently read one of my articles about how some unscrupulous cardiologists rip-off insurance companies: http://www.leftistreview.com/2013/10/29/the-best-healthcare-system-in-the-world/evanlevine/. After reading my article his response included the following: “I know it has been years since we have spoken. As you can see, my career has taken an interesting turn”.
Upon reflection, I tell myself, “With this in mind, I have to say his review of my articles is really excellent”.
I wondered if UHC tossed me out because of my credentials: I graduated Summa Cum Laude from a highly competitive six-year medical program and received honors, at Mount Sinai in Junior and Senior Medicine as well as Surgery. I’m boarded in three specialties and have always passed with high grades. I suspect that this was not the reason.
Perhaps I am not honest in providing care: I have not accepted any invitations to speak for big Pharma for over 15 years; and I do not take part in rental schemes with internists to obtain consult. I am known not to allow my patients to participate in any drug trials unless they may benefit from that trial. I make decisions that are best for the patient, even if unpopular, and have sent patients to hospitals, where I am not on staff, my I when I felt it was best for the patient.
Perhaps I bill too much or increase cost to UHC and other insurers: According to published data by the non-profit site Propublica : http://projects.propublica.org/checkup/ the average cost for a Medicare prescription filed by Dr. Evan Levine was $48.22 , making me one of the least costly prescribers in the country! A cardiologist that was allowed to stay in UHC Advantage, by comparison, had an average cost of $87.83 per prescription. Multiply that by over a few thousand prescriptions in a year and I think I practice very cost-effective medicine, especially compared with most of the cardiologists that were not thrown out of UHD Advantage. And by the way, the physician who I compared my prescription drug costs to does prostitute himself to Pharma and takes home a nice remuneration for lecture fees.
So I ask you President Obama, as well as the president of UHC, why I was thrown out of UHC Advantage Care without warning if I am well trained, if a most senior member of your company tells me that my articles about healthcare are excellent, and if I am one of the most cost-effective practicing heart doctors in the country? Why?
About the author: Dr. Evan S. Levine is a cardiologist in New York and a Clinical Assistant Professor of Medicine at Montefiore Medical Center – Albert Einstein College of Medicine. He is also the author of the book “What Your Doctor Won’t (or Can’t) Tell You”. He resides in Connecticut with his wife and children.