Close Close
Popular Financial Topics Discover relevant content from across the suite of ALM legal publications From the Industry More content from ThinkAdvisor and select sponsors Investment Advisor Issue Gallery Read digital editions of Investment Advisor Magazine Tax Facts Get clear, current, and reliable answers to pressing tax questions
Luminaries Awards

Life Health > Long-Term Care Planning

New York: Insurer can’t make its commercial plan providers join a Medicare plan network

Your article was successfully shared with the contacts you provided.

New York state regulators are blocking what they say was an effort by a unit of UnitedHealth Group Inc. (NYSE:UNH) to use its market clout to offer commercial-plan-level providers to enrollees in a Medicare Advantage institutional special needs plan (I-SNP).

Originally, UnitedHealth required some skilled nursing facilities (SNFs) in its commercial-plan provider networks to join the I-SNP’s network, according to New York State Attorney General Eric Schneiderman.

UnitedHealth has neither admitted nor denied Scheiderman’s findings, but it has agreed in a settlement with Schneiderman to let the SNFs in its commercial-plan networks decide whether or not they want to serve the I-SNP patients. 

UnitedHealth also agreed to pay $100,000 to New York state, officials said. 

An I-SNP is a Medicare Advantage plan that provides coverage for people who are living in a nursing home or getting long-term care (LTC) services in some other setting.

See also: Provider network storm gains strength

Also, an I-SNP provides extra care coordination services and preventive services benefits on top of the regular Medicare Advantage plan benefits. It also may pay an enrollee’s nursing home for some acute health care services, to try to reduce the risk of moving the patient to another health care facility which might hurt the patient.

Members of the I-SNP might like to have access to the nursing homes available in UnitedHealth’s commercial-plan networks, but Schneiderman argued in a statement about the settlement that requiring a commercial-plan nursing home to join an I-SNP provider network creates antitrust problems, by shutting out competition from alternative I-SNP providers. 

“Free and fair competition among service providers is crucial to ensure that patients receive the highest levels of service at the lowest possible cost,” Schneiderman said in the statement.

Representatives from UnitedHealth were not immediately available to comment on the settlement.

See also:

Group Rules On Sublets Of Doctor Networks

Should the New Plan Summaries Warn About Balance Billing?

Lawmakers propose Medicare plan network stability standards


Have you followed us on Facebook?


© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.