United Health Care Contract update
To all our patients who are insured by United HealthCare,
Update as of July 11, 2022
Effective Immediately, we are contracted with UHC. Should you have any questions or concerns, please do not hesitate to contact us. We would like to thank each and everyone of our patients that stuck by us during this difficult contract negotiation.
We would like to clarify some issues related to the ongoing dispute between UHC and our practice, and want our patients to understand that we care deeply about your well-being and will not leave you without proper medical care.
As of March 1 st , 2022, United HealthCare decided to unilaterally change the terms of our contract, which had been mutually signed previously. Without notice, they simply decreased reimbursement to the practice for all services, by a very large amount. This decrease was not announced to us in any way prior to taking effect, and was of such significant amount that it would make it impossible for us to continue providing proper care to the patients. When insurance chooses to pay the practice even less than the cost of the medications being infused, it becomes unfeasible for the practice to continue providing the service.
We have made multiple attempts to negotiate with the insurer, which were mostly ignored. We have not given up, but in order to help our patients make decisions, we have chosen to terminate the agreement for the time being.
That said, this does not mean that we will no longer see our UHC patients. You have the choice to be seen in the practice and remain an active patient, but since we will be out of network, office services will be self-pay. We will provide you with a receipt, which you can use to file with your insurance for whatever out -of-network benefits your policy allows.
We like to remind patients that office visits are often the smallest part of the cost of medical care.
Prescriptions, labs and imaging, which are the most costly, are still covered by insurance if done in contracted locations, even if the prescriber is not in network. Several labs, including the hospital based labs, Quest and LabCorp, as well as most radiology providers still contract with the insurance, and prescriptions are covered regardless of prescriber. The only services that cannot be covered are infusions of biologics, which have been previously done in our office but can no longer be offered because of the cost of biologic medications.
Many of our patients have chosen to continue with the practice. For those who choose to get care elsewhere, we will continue to provide you with prescriptions, advice and monitoring, until you get established with a new provider. We will also forward your records once you have informed us where you would like to have them sent.
This decision was a big struggle, because we care deeply about the patient relationships we have formed over the years. But unfortunately, there is a cost to running a business, and if the reimbursement is not sufficient to cover that cost, the business cannot stay afloat.
We urge our patients to contact their employers and let them know about this problem, as it has not been limited to our practice. It is a well-known fact that UHC is in contract disputes with practices across the state and country, both large and small.
The physicians at Triangle Arthritis & Rheumatology Associates
Last week the American College of Rheumatology released new guidelines to help physicians and patients navigate the Covid vaccines and their medications for autoimmune diseases.
Here is a list of recommendations, which may help guide you. If you have any further questions, please reach out to our office.
- MEDICATIONS THAT DO NOT REQUIRE ANY CHANGE TO THE MEDICATION OR VACCINE TIMING (no need to stop the medicine, proceed with vaccination)
Glucocorticoids, prednisone-equivalent dose <20mg/day:
Cyclophosphamide (Cytoxan – oral);
TNFi (Remicade, Inflectra, Renflexis, Avsola, Humira, Enbrel, Cimzia, Simponi, Simponi Aria);
IL-6R (Actemra, Kevzara);
IL-17 I (Cosentyx, Taltz);
oral calcineurin inhibitors (Cyclosporin, Tacrolimus, Pimecrolimus)
Glucocorticoids, prednisone-equivalent-dose≥ 20mg/day**
- MEDICATIONS THAT SHOULD BE HELD FOR ONE WEEK AFTER THE VACCINE DOSE:
Hold MTX 1 week after each vaccine dose, for those with well-controlled disease; no modifications to vaccination timing
***For patients with very active disease, please contact your doctor for guidance.
- Abatacept (Orencia) SC (weekly shots given at home)
Hold SQ abatacept both one week prior to and one week after the first COVID-19 vaccine dose (only); no interruption around the second vaccine dose
- Abatacept (Orencia) IV (in-office infusion)
Time vaccine administration so that the first vaccination will occur four weeks after abatacept infusion (i.e., the entire dosing interval), and postpone the subsequent abatacept infusion by one week (i.e., a 5-week gap in total); no medication adjustment for the second vaccine dose
- Cyclophosphamide (Cytoxan) IV infusion
Time Cyclophosphamide administration so that it will occur approximately 1 week after each vaccine dose, when feasible
- RITUXIMAB (Rituxan) IV infusion
Assuming that patient’s COVID-19 risk is low or is able to be mitigated by preventive health measures (e.g., self-isolation), schedule vaccination so that the vaccine series is initiated approximately 4 weeks prior to next scheduled rituximab cycle; after vaccination, delay RTX 2-4 weeks after 2nd vaccine dose, if disease activity allows.