Physicians in some Northern California counties were recently notified that they would automatically be included in United Healthcare’s Medicare Advantage network effective January 1 unless they opt out in writing within 30 days. Physicians are advised to review the proposed addendum and fee schedule carefully as some physicians have reported that some fees are significantly below Medicare fees.  The notice contained a “representative” fee schedule and informed physicians that they can obtain an expanded Medicare Advantage fee schedule by contacting the insurer.

Physicians who wish to opt out of United’s Medicare Advantage network must do so in writing. Opt-out letters should be sent certified mail with return receipt to United Healthcare, Centralized Physician Contracting, 8800 Grand Oak Circle, STE 100, Tampa, FL 33637.

Physicians should be aware that although United Healthcare’s notice states that the physicians must opt-out of the Medicare Advantage product within 30 days of receipt, California law requires insurers to provide contracted physicians with at least 45 days' notice of a material change to the contract and the opportunity to terminate the contract.

CMA has created a simple worksheet to help physicians analyze this and other proposed fee schedules and assess the financial impact on their practices based on their most commonly billed CPT codes. The worksheet is available to members at the members-only website.

CMA has also published a contracting tool kit, to help physicians analyze proposed fee schedules and negotiate and manage complex third-party payor agreements. The tool kit, “Taking Charge: Steps to Evaluating Relationships and Preparing for Negotiations—A Focus on Payor Contracting,” is available free to members at the members-only website. Nonmembers can purchase the tool kit for $100 in the CMA bookstore.

Contact: Reimbursement help line, 888/401-5911 or drice@cmanet.org.