Austin

5,000 Medicare patients say they suddenly lost access to their doctors

AUSTIN (KXAN) — About 5,000 Medicare Advantage patients in Central Texas say they've suddenly been cut off from their go-to doctors. 

Austin Regional Clinic told us they knew they wouldn't be an in-network provider with United Healthcare for Medicare Advantage patients beginning next year. 

ARC expanded some programs, and those changes led to ARC and United Healthcare respectfully and mutually deciding to end their contract. 

United Healthcare told us ARC providers remain in their network and are available through their directories for the remainder of the 2018 year.

However, that's not what K.C. Cerny and other patients experienced this week. 

Cerny said he's been seeing Dr. Anas Daghestani at ARC for about a decade. 

"It's more than comfort," Cerny said while explaining why he likes seeing the same doctor. "I come from a family that has a history of a variety of chronic diseases, and so having an internist who is familiar with the early onset of cardiac and other complications that have run in my family, [that is] something that's important to me."

He said he received a letter from United Healthcare this week, saying he's been assigned a new doctor beginning October 1st. 

He has an appointment with Daghestani coming up in December, so he said he called United Healthcare. 

"I said, you know I'd like to stay with Dr. Daghestani through the end of the contract, I don't want to see somebody else," he said. "The woman says I should be able to help you with that. I get put on hold. Some minutes later, she returns and says I will not be able to re-assign you to Dr. Daghestani."

"Really what caught us off guard is the quick cutoff of patients from their physicians," said Daghestani, who's also President and CEO of ARC. "Losing access to their doctor in a period of 2-3 days, it's just not right. Not ethical. We're very concerned about it."

He said the patients affected are 65 or older, often dealing with chronic illnesses or at higher risk of other diseases.

"It's our father, mother, grandfather, grandmother," he said. "They tend to have more diabetes, more heart failure. More active conditions. You just can't take a vulnerable population, a population that is more dependent on access to their physicians than probably any other population, and then expect them over a week, to readjust, find a new doctor."

Daghestani said the contract is clear Medicare Advantage patients should have access to their ARC doctors through the end of the year.

In this situation, if those patients want to stay with ARC in 2019, they'll have to choose a different plan when open enrollment begins. Daghestani says the patients will learn what their options are on October 1st.

"You probably don't trust anybody managing your financial asset, and you're very engaged," Daghestani said. "You should be as engaged around your most important asset, which is your health."

When asked about the contract that will end on December 31st, 2018, UHC said, “We are disappointed with ARC’s decision to end its participation in our network. Our top priority is ensuring our members transition smoothly and have continued access to the care they need.”


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