United has dropped some doctors in retainer practices

UnitedHealthcare is dropping some physicians with retainer practices from its network, saying the annual fee they charge to patients pays for services included under United's standard physician contract.

The fee covers customized care such as a comprehensive physical, 24-hour access, house calls, and extended appointments -- services that physicians in retainer practices say traditional practices typically would not provide. Retainer practices often limit patient loads to 500 or fewer.

United spokeswoman Cheryl Randolph said the company believes "it's perfectly fine for physicians to have these types of practices." But she said that many retainer practice services already are covered, causing its members to pay more than the physician's contracted reimbursement rate.

United has recently dropped six doctors associated with Boca Raton, Fla.-based MDVIP, a national network of about 220 physicians in retainer practices.

John Burpeau, MD, a Houston internist and one of the dropped physicians, said his retainer fee covers care that a health plan would not pay for. Dr. Burpeau said he and his patients made claims through United only for sick visits.

While many of these physicians eschew insurance, some do accept it to keep patients they used to see in their nonretainer practices. Or, they will accept insurance from patients while the physicians are still contracted with plans, then drop it when the contracts expire.

Medicare has established that physicians may not charge a retainer fee for any service that is already covered under the program.

United is rare among private health plans in taking a hard-line stance against retainer practices.

Other major insurers, including Humana and Aetna, said they are fine with the practice as long as they are not billed for the retainer fee or what it covers. Cigna says the company has no problem with the fee as such but will continue to drop physicians for refusing to treat Cigna members who either can't, or won't, pay it. Cigna spokeswoman Amy Turkington said this happens infrequently.

Doug Danzeiser, a spokesman for the Texas Dept. of Insurance, said it has found a couple of provisions in United's contract with physicians that allow for the terminations.

Darin Engelhardt, president of MDVIP, said he hopes to change United's stand on retainer practice and avoid future terminations by stressing its preventive approach.

"We don't view the fee as a retainer fee, but [as] the cost of a broad-based physical, screening, wellness planning, etc., which is what makes insurance companies more comfortable with us," Engelhardt said.

Thomas LaGrelius, MD, president of the Society for Innovative Medical Practice Design, a national organization of physicians with retainer practices, has taken another approach. He said he no longer accepts any major health insurance plans at his retainer family practice in Torrance, Calif.

"Insurance companies have a role," he said. "You can't get along without [them] for big items like surgery. But it's not always necessary for primary care physicians."

AMA policy says physicians in retainer practices are "ethically required to be honest in billing for reimbursement, and must observe relevant laws, rules and contracts."

It says it is "desirable" that contracts with patients separate special services and amenities from reimbursable medical services.