Federal Appellate Court Orders United Healthcare, Physicians to Mediation

A federal appellate court in New York has ordered a dispute between United Healthcare and two county medical societies to mediation.  The lawsuit reportedly arose in October 2013 after the insurer removed thousands of doctors in Connecticut and other states from its Medicare Advantage network.  In December, a federal court in Connecticut kept the physicians in the insurer’s network by issuing a temporary injunction.  The injunction effectively provides doctors who were cut from the program with the opportunity utilize the company’s internal appeals process and engage in arbitration with the insurer.

United Healthcare appealed the federal court’s decision and oral arguments were held in January.  According to the medical societies of Fairfield and Hartford counties in Connecticut, United Healthcare breached its contract with terminated doctors by unlawfully removing them from the Medicare Advantage network without cause or sufficient notice.  The insurer reportedly maintains that the company acted within its legal rights when it decided upon the cost saving measure.  Following oral argument, the parties were instructed to engage in mediation.

The resolution of the case will likely affect many more physicians across the nation.  A similar lawsuit filed by the Medical Society of the State of New York is currently on hold pending the outcome of United Healthcare’s appeal.