UnitedHealthcare, the nation’s largest managed-care insurance company, was recently taken to task by the assistant secretary of defense for causing delays in medical treatment. The company expanded its presence on the islands and elsewhere when it won a six-year, $20 billion Department of Defense contract to take over administration of the western region of the federal Tricare health insurance program for active-duty military, retirees and their dependents.
How big is UnitedHealthcare? It collects approximately $67 billion in annual premiums and accounts for almost 12 percent of the national insurance market. Its parent oversees care for 75 million lives worldwide.
Delays in access to care have become a widespread concern since UnitedHealth took over the Tricare contract April 1, according to the Minneapolis Star Tribune newspaper. UnitedHealth is based in Minnetonka, Minn.
Dr. Jonathan Woodson, assistant secretary of defense for health affairs, wrote to the military services’ top personnel officials saying that UnitedHealthcare Military & Veterans, a UnitedHealth business, failed to meet contract requirements for referral and authorization management.
Rep. Doug Lamborn (R-Colo.), member of the Armed Services and Veteran’s Affairs Committee, complained that as soon as UnitedHealth assumed the contract on April 1 of this year he began to hear from health providers and military members that a multitude of errors and glitches prevented referrals from being processed.
Doctors complained of weeks-long waits for patients to get UnitedHealth paperwork required to see medical specialists, the Star Tribune reported.
In response the DoD took unusual emergency measures to bypass normal referral requirements and institute a waiver period during which patients needed only a written referral for specialty care from their primary physicians. This placed an additional burden on the internal referral system at the DoD, which is already short-staffed from a hiring freeze and furloughs. Originally the waiver system, designed to give UnitedHealth an opportunity to correct deficiencies, was to expire May 18. Because of continuing problems, the waiver was extended twice more through July 2.
At the end of the waiver period, UnitedHealthcare Military & Veterans apologized for delays they said were caused by an unexpectedly large caseload. The company also announced that it has made measurable progress and reaffirmed its commitment to timely access for beneficiaries.
According to the Star Tribune, UnitedHealthcare Military & Veterans transferred its CEO to another division of its corporate parent, installed a president who once served as an undersecretary of defense and hired a retired admiral as its chief medical officer.
Yet, damage has been done. According to Lamborn, providers and vendors in the Colorado Springs, Colo., area have seen their pipeline of military patients slow dramatically. This has jeopardized many businesses that rely on the military for much of their volume.
The UnitedHealth problems have also been felt here in Hawaii.
The Niolopua Sleep Wellness Center at Manakai, which I co-founded, opened at the Honolulu Club Building in January after substantial investment. The facility, which emphasizes a comprehensive, whole-person approach to sleep disorders, has been well received by the military. However, payments from UnitedHealth have been extremely slow in coming despite extensive efforts to work with the insurer.
Military Medical Supplies is another company that has been working with UnitedHealth in Honolulu. According to David Scheidt, its CEO, "It is apparent that the UnitedHealth model has some basic flaws including poor communication, lack of human resources and not enough technology to verify patients, claims and payments. It is a long uphill battle. I think every provider and vendor is being affected by this transition. Some may not survive. Others will survive, but only if they discontinue services to the U.S. military."
"We were in a financial crisis and had to make some tough decisions to stop providing products and services until we got paid," Scheidt said. "The concern, as always, was the impact to soldiers and their dependents. We have decided to stick it out and make sure our military members are taken care of."
Men and woman in uniform who serve our country have, together with their families, made great sacrifices. It is unconscionable that referrals made by their military physicians for specialty medical care in the civilian sector fall through the cracks of the country’s largest health insurer. Damage to small health care businesses in the local community dedicated to serving the military population is also troubling. When a pressing need for medical care goes unanswered, human suffering worsens and, in the end, costs increase.
Nevertheless, America’s largest insurer became No. 1 because it is good at what it does. Its $20 billion dollar government contract to care for military beneficiaries is a massive undertaking and will take time to refine and perfect.
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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
