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United Healthcare and Harken Health
Dec 16, 2015

 We know that many of you are making choices about your 2016 medical insurance. To assist you we have received the following information about United Healthcare and Harken Health.

Two years ago United Healthcare began selling insurance products that limited patients’ choice of physicians. Two plans that we accept are the “Choice” HMO type insurance offered to employer groups and the “Compass” HMO or Harken Health offered via the state healthcare exchange. For these plans doctors are rated by United as Tier 1 (Preferred/Premium) or Tier 2 (General) Physicians.


United rates physicians by 2 categories: Quality and Cost Effectiveness. Only doctors who are deemed both Quality AND Cost Effective can receive a Tier 1 rating. After extensive research and discussion with United we are still unclear on the details of the rating program and disagree with how cost effectiveness ratings are determined. Cost effectiveness is how much the doctor costs the insurance plan based on patient claims data. In general these ratings do not always reflect the quality of the doctor; just the expense associated with the doctor. All of our doctors have achieved a Quality rating. Some of our doctors have not been deemed Cost Effective and therefore do not have a Tier 1 rating. These rating appear to change at least annually, at the discretion of United Healthcare.


What does this mean for you? If you are covered under one of these United Healthcare plans you may experience higher cost sharing depending on which doctor in our office you see at a particular visit. You might have a $25 copay if you see one doctor and a $50 copay if you see another one of our doctors. Some services may have a deductible if administered by a Tier 2 physician.


To be clear, this physician network tiered system is a United Healthcare policy- not ours. We do not control which doctors are preferred and when the ratings may change, nor do we have control of what claims data is used to determine the ratings. These are plans that you or your employer have chosen. Furthermore, a Tier 2 doctor is not necessarily less competent or capable. These ratings do not necessarily reflect the actual quality of a physician’s care.


We want you to have this information proactively so you can make decisions when choosing your insurance and when scheduling appointments. Unfortunately, at the time you schedule an appointment we cannot determine which physicians are in Tier 1 vs. Tier 2. You may want to contact United to check on Tier status before calling our office to schedule an appointment. Per our contract with United we cannot “write off” any of the copay, co-insurance or deductible.


If you have additional questions about these United plans please feel free to contact Donna Scowden, Practice Administrator, at 404-351-1131.