UnitedHealth to Buy Patient Care Group; Group Not to See Patients with UnitedHealth

UnitedHealth Group Inc. announced Wednesday December 4 that it is spending $5 billion to purchase "hundreds of clinics," many of which are disallowing patients covered by UnitedHealth to be seen in the coming year. The announcement came days "rival Aetna announced a tie up with CVS Health Corp."

The Minnesota-based UnitedHealth's Optum segment is expected to close the deal to purchase DaVita Medical Group from DaVita Inc. next year, according to an AP article in the Tampa Bay Times ("UnitedHealth ventures deeper into patient care with $5B deal").

DaVita "runs nearly 300 primary and specialty care clinics in several states," including Florida, while Optum currently operates more than 1,100 primary, urgent care and surgery centers.

However, patients in at least one Florida county are finding it increasingly impossible to continue to see their primary care physicians employed by DaVita Medical Group while insured by UnitedHealth.

Disclaimer: This writer, along with at least one family member, were insured through UnitedHealth through December 2016; I write this from experience.

During the 2016 open enrollment period for Medicare, DaVita Medical (then called JSA Medical) contacted patients covered by UnitedHealth, informing patients that they needed to change from UnitedHealth to another Medicare Advantage Plan or find another primary care physician. A contract between UnitedHealth and DaVita was not signed until shortly after the open enrollment period ended. Those patients who opted to stay with UnitedHealth found themselves in the position of then staying with both their insurance of choice and retaining their primary care physicians in DaVita. Those who changed insurance plans to stay with DaVita were at least able to find comfort in staying with their primary care doctors.

However, not all plans are the same. Some patients (again, this writer and my family member(s)) would that many of their specialists were not covered with new advantage plans. When the 2017 open enrollment began, patients who had fled UnitedHealth (UHC) the previous year found that if they switched back to UHC, they could either see their DaVita physicians as an out-of-network doctor, or not be allowed to see their physicians, even as out-of-network, depending on who one spoke with. (Out-of-network refers to doctors who are not technically part of one's insurance plan, but who can still be seen, usually at a slightly higher co-pay.)

As of December 7, the last day of open enrollment for the 2018 coverage year, only those patients who remained with UHC in 2016 were allowed to see their DaVita doctors, being "grandfathered" in. Those patients who changed to UHC during open enrollment - including those who switched out of UHC last year due to too-late contract negotiations - would have to change doctors.

According to a customer satisfaction representative at the St. Petersburg (Fla.) corporate office, while UnitedHealth Group is poised to close the deal to buy DaVita Inc. in 2018, Medicare patients wanting to switch back to UHC can not do so and stay with DaVita.

"That might change next year, if everything falls into place in time," the representative stated. "If not, it might be during the 2019 open enrollment before a patient could change back."