The decision, however, modified a temporary injunction issued by the U.S. District Court in Bridgeport that halted UnitedHealthcare's plan to cut thousands of Connecticut doctors from its Medicare Advantage network.
That injunction is modified to give the aggrieved doctors up to 30 days from Feb. 7 to challenge their removal from the insurer's network through arbitration — and the doctors can seek emergency or injunctive relief from the arbitrator in order to continue to remain in the network.
The decision was issued Friday by a three-judge panel at the 2nd U.S. Circuit Court of Appeals in New York. The case could continue in the Bridgeport court or doctors who are members of either the Hartford County Medical Association or Fairfield County Medical Association could take their case to an arbitrator.
The judges denied UnitedHealthcare's request for a stay of the U.S. District Court's decision, and they rejected the insurer's claims that the doctor groups didn't have standing. The judges struck down UnitedHealthcare's argument that the legal battle was insubstantial.
Both UnitedHealthcare and doctors claimed victory.
"We are pleased that the court determined the injunction should be lifted in short order and are happy to work with physicians who have concerns about their status, even as it remains essential to offer networks that provide better health outcomes and more affordable coverage for our members," UnitedHealthcare spokeswoman Jessica Pappas said in a prepared statement.
Fairfield County Medical Association's executive director, Mark Thompson, said he was pleased with the decision because arbitration will require the insurer to explain why, exactly, these doctors were cut from the network.
"This decision is a victory for both health care and justice — patients and doctors," U.S. Sen. Richard Blumenthal, D-Conn., said in a prepared statement. "I will continue to fight for basic fairness and patient choice to assure access to quality care."
Cutting Yale-New Haven
Also Friday, UnitedHealthcare acknowledged it is cutting Yale-New Haven Health System from its Medicare Advantage network after March 31, with two exceptions. Bridgeport Hospital and Greenwich Hospital will remain in network. Other hospitals, such as Yale-New Haven and the Saint Raphael campus in New Haven, will be out of network starting April 1, and customers will face higher out-of-pocket expenses as a result.
People who have UnitedHealthcare Medicare Advantage plans will be receiving letters telling them about the network change, according to the insurer.
Gov. Dannel P. Malloy on Friday referred patients affected by UnitedHealthcare's decision to the state Department of Aging's CHOICES program to get assistance re-enrolling in traditional Medicare by the program's deadline of Feb. 14. The CHOICES program has counselors who can help people enroll in traditional Medicare, which is different from Medicare Advantage plans offered by private insurers.
"Individuals who want to keep their doctors at Yale-New Haven can do so by un-enrolling from the UnitedHealthcare Medicare Advantage Plan and re-enrolling in original Medicare," Malloy said in a statement. "I encourage seniors to speak to one of the great counselors at CHOICES who stand ready to help navigate this transition. Seniors who were affected by this change only have a week to re-enroll, so they must act quickly."
It's a difficult decision because there are certain benefits Medicare Advantage plans have over traditional Medicare, said Thompson, head of the Fairfield County Medical Association.
Additionally, people have to figure out whether they are better off financially by remaining with UnitedHealthcare and paying out-of-network rates if they want to go to Yale-New Haven facilities, or paying the usual out-of-pocket costs that come with traditional Medicare.
UnitedHealthcare is directing its patients in the New Haven area to seek hospital services at Bridgeport Hospital; Griffin Hospital in Derby; Midstate Medical Center in Meriden; Milford Hospital; or Saint Vincent's Medical Center in Bridgeport.
UnitedHealthcare has about 58,000 Medicare Advantage members in Connecticut, roughly the same number it had last year.
Pappas, the UnitedHealthcare spokeswoman, said, "Our focus remains on supporting our members, and we encourage any member who has questions to call us directly at the number on the back of their membership card or at 1-888-332-8883."