March 13, 2020
Area(s) of Interest: Practice Management
UnitedHealthcare (UHC) is introducing a new narrow network product, the Doctors Plan, into the California marketplace. While details of the Doctors Plan are still being finalized, UHC has indicated that it will be an EPO (exclusive provider organization) with a significantly narrowed network of participating physicians that is a subset of its established PPO network. UHC is awaiting regulatory approval on this product before determining an effective date.
UHC plans to offer the new product in the following counties:
- Southern California: Los Angeles, Orange, Riverside San Bernardino
- Northern California: Alameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara, Santa Cruz, Solano and Sonoma
Similar to its other narrow network products Core and Navigate, UHC will be utilizing a subset of its larger PPO network for this product coupled with its wrap network, named W500, which will include the remaining PPO providers not selected to participate in the Doctor’s Plan. Patients can only access physicians in the W500 network for emergency services and related admissions, urgent care services and other prior approved services.
UHC has sent contract amendments to physicians it will be including in its W500 wrap network. The amendment for the W500 product does not allow physicians to opt out of just the new product; rather, physicians would have to terminate their underlying United Healthcare PPO agreements in order to opt out of participation in the new product. Physicians will have 45-days from the date of receipt of the amendment notice to notify UHC if they wish to terminate their participation.
The California Medical Association (CMA) is working with United Healthcare to obtain additional information about the product and its roll out.
As always, physicians are encouraged to carefully review all proposed amendments to payor contracts. Remember, you do not have to accept substandard contracts that are not beneficial to your practice.
Physicians who are unsure whether or not they are affected by this change, those who have general questions about the amendment or those who wish to dispute their performance rating for participation in the W500 or Doctor’s Plan Network can contact United Healthcare Network Management at (866) 574-6088, option 1.