November 21, 2022
UnitedHealthcare (UHC) in August announced it would begin migrating some physicians to an updated commercial fee schedule. The fee schedule update for its PPO product—happening in three phases—have been moving physicians on older fee schedules dating back to 2008 to a new 2020 UHC commercial fee schedule based on 2020 CMS RVU values.
As part of the update, affected providers will receive a letter notifying them about the fee schedule transition. Providers will receive a UHC Notice of Amendment, samples of the new fee schedule for reference and a new Payment Appendix to be attached to the provider’s existing UnitedHealthcare participation agreement.
The notices for physicians being moved to the new fee schedule in the third phase will be mailed on December 1, 2022, to approximately 8,000 contracted providers. UHC will continue to update providers on old fee schedules as they are identified as part of ongoing network maintenance.
Physicians do not need to sign or return the contract amendment to UnitedHealthcare for the fee schedule changes to take effect. However, providers who would like additional information regarding this change, object to the amendment, , or want to confirm whether their practice is affected, or wish to terminate their entire agreement with UnitedHealthcare, should contact their Network Account Manager directly or email UHC at email@example.com.
Physicians are encouraged to carefully review all proposed amendments to health plan or medical group/IPA contracts CMA has developed a simple worksheet that will help physicians analyze the impact fee schedule changes may have on their practices based on commonly billed CPT Code. CMA’s Financial Impact Worksheet is available free to CMA members on our website.
The California Medical Association (CMA) reminds physicians that they do not have to accept substandard contracts that are not beneficial to their practice.
To help physicians understand their rights when a health plan has sent notice of a material change to a contract, CMA has published "Contract Amendments: an Action Guide for Physicians." The guide includes a discussion of options available to physicians when presented with a material change to a contract.
Contact: CMA's reimbursement helpline, (888) 401-5911 or firstname.lastname@example.org.