UnitedHealth Purges Rheumatology Clinic, Patients Left Scrambling
Dropping Triangle Arthritis from its Medicare Advantage network is part of a wider strategy to cut high-cost doctors and dump vulnerable patients.
Dr. A. Silvia Ross co-founded Triangle Arthritis & Rheumatology Associates in Raleigh, N.C., in 1994, and she says she has a handful of patients who’ve been with her since the very beginning. That’s not surprising given both the chronic nature of the illnesses that she manages and the nation’s severe shortage of rheumatology clinics – with patients reporting that an appointment at nearby facilities like Duke University or the University of North Carolina often requires a 17-month wait.
That’s why Ross was stunned recently to get a letter from the nation’s largest health insurer, UnitedHealthcare, that it’s dropping Triangle Arthritis from its network of Medicare Advantage providers in October. That means at least 200 of their patients, who mostly require costly infusions, will have to quickly find a different doctor or sign up for a rival insurer. Some might put off needed treatments.
In October, Ross said, her rheumatology patients are “going to have to scramble because they're going to realize, ‘Oh man, I can't see my doctor anymore.’ And it's going to harm a lot of patients. These are patients who – a lot of them – get intravenous infusions with highly expensive medications, whose diseases are brittle and will flare.”
There’s mounting evidence that what’s happening to Ross and her North Carolina clinic isn’t going to be an isolated incident. Instead, her practice may be on the cutting edge of a trend, as Big Insurance looks to preserve profit margins by dropping doctors who treat its often older, sickest patients.
Massive parent company UnitedHealth Group – which has seen its stock price plunge in 2025 under heightened scrutiny from angry patients, investors and government – appears to be leading the charge. How do we know this? The company’s executives told their investors that this was their strategy in blunt terms during an earnings conference call this summer.
"We are shifting to narrower networks and focusing on more disciplined managed products, particularly in Medicare Advantage," Tim Noel, CEO of UnitedHealthcare, said in July’s midyear earnings call. This was part of a longer discussion about the insurance giant’s rising expenses, which it generally blames on higher costs for some treatments and by making allegations of overbilling by some physicians.
To achieve “narrower networks,” UnitedHealth may simply drop physician practices or clinics that treat the sickest patients – especially in specialities such as rheumatology or oncology, which tend to provide more expensive treatments such as costly new infusion drugs. Analysts expect UnitedHealth Group will also stop offering coverage in certain ZIP codes with older or sicker populations to boost its bottom line.
“It's because their earnings are down, their stock's been hammered, and Medicare [Advantage] is a big problem, especially from an expense standpoint,” said Ron Howrigon, the president of North Carolina-based Fulcrum Strategies, which works with medical practices and rural hospitals. He said as treatment costs trend higher, UnitedHealth’s plan is now, “Let's get rid of doctors who care for sick people and make those sick people go to somebody else.”
Of course, it’s patients, especially the most vulnerable, who are harmed by such strategies. Despite mounting pressures, UnitedHealth Group made a whopping $34.4 billion in operating profits in 2024, but it has signaled to Wall Street that it might make slightly less than that this year. That’s why many health plan enrollees may soon find their doctors have been kicked out of UnitedHealthcare’s network. The chaos will likely cause some sick people to delay or forgo treatment – all to help the company reverse its slide at the New York Stock Exchange.
This insidious practice is nothing new, nor is it unique to UnitedHealth. In the 2010s, some health care analysts described a similar purging as “economic credentialing,” a rather bloodless way to explain schemes to cull the sickest and neediest people from an insurance company’s roster. Howrigon recalled his involvement with such an effort when he worked on the other side, as an executive at Cigna (overlapping with my time at that company), and was asked to drop 1% of the costlier doctors from the network (after initial talk of a staggering 10% reduction). He said he slashed 150 doctors in Cigna’s network in North Carolina, many of whom struggled to understand why.
Howrigon recalled getting a phone call from the administrator of a small cardiology group, who was livid after he’d terminated the group for Cigna. “She said, ‘You know, I'm going to tell all my Cigna patients to go switch to Blue Cross.’ And I said, ‘you understand what you're threatening me with? You're going to tell all your cardiac patients to leave my insurance company and go to my competitors. I mean, can I pay for the postage?’”
Still, this new tack from UnitedHealth is somewhat surprising because no big insurer in recent years has come under such negative scrutiny over its patient-unfriendly business practices. The company has faced mounting bad publicity and heightened awareness about its aggressive use of tactics such as prior-authorization rejections to control costs, causing needless delays or preventing treatment for sick people.
Ironically, it took a high-profile tragedy – the midtown Manhattan assassination of Noel’s predecessor, Brian Thompson, who was shot in December 2024 – to put UnitedHealth’s longstanding corporate practices under the glare of attention on social media and in the news. Thompson’s murder triggered a flood of anecdotes on social media from patients telling horror stories about denied or delayed claims or unexpected bills from the insurer.
This proved only the start of a nightmarish 2025 for UnitedHealth Group, which encompasses both UnitedHealthcare, the insurer, and Optum, the large division that owns and operates thousands of physician practices, clinics and other health care delivery facilities. The company missed earning forecasts for two consecutive quarters, ousted its former CEO Andrew Witty, and learned that it faces a U.S. Department of Justice investigation for possible Medicare fraud. The run of bad news caused the company to lose half of its value on Wall Street – a $280 billion hit on paper.
Yet UnitedHealth’s summer earnings call suggested that the insurer has little interest in changing its controversial ways. Instead, the company’s executives blamed physician billing practices and higher treatment costs for its smaller profit margins and said they are seeking ways to reduce its costs.
In addition to its “narrower networks” – the euphemistic way of saying that it’s dropping doctors like those in Ross’s clinic in Raleigh – Noel and other company executives said on the recent earnings call that UnitedHealthcare is also pushing patients into “more disciplined managed products,” which means HMOs with tighter cost controls. Some analysts believe this is UnitedHealthcare’s response to increased use of artificial intelligence, or AI, by physicians looking to increase their billing or to have a better chance of overturning a prior-authorization denial.
But getting rid of cancer, cardiology, or arthritis patients, whose care is a drag on UnitedHealth’s ledger, is another way to improve earnings.
Howrigon said the theme of the recent earnings call was to assure investors that it’s doing everything it can to pay out less in medical expenses. He noted that executives boasted, “We have stepped up our audit, clinical policy and payment integrity tools to protect customers and patients from unnecessary costs. That's denials. That's prior authorization. That's all that crap that everybody hates.”
Howrigon said it shows what matters to a giant insurance company. “The people they were talking to on the investor call are a whole lot more important than the public,” he said. “And those people are punishing them by hammering their stock price.” He said UnitedHeath unsurprisingly went with making Wall Street happy by chasing higher earnings – and not worrying about bad press.
Ross, the rheumatologist, said this hasn’t been her first difficult dealing with UnitedHealth. In 2017 the company told her clinic it would sharply reduce reimbursements, which triggered a brief standoff in which her office stopped seeing some patients until UnitedHealth relented and negotiated a fairer price. This time, Ross is appealing UnitedHealth’s move. Although the insurer is only planning to drop the clinic from its Medicare Advantage network, not its conventional commercial insurance, Ross said dropping those patients would only harm them, and her business – not the third largest corporation in America, which UnitedHealth became this year.
“It's a tragic situation for a small practice like mine to navigate this,” Ross said. “And it's unfair to the patient, it's unfair to the practice, and at the end of the day, they [UnitedHealth] are the only ones that are going to win because they are just going to get rid of their expensive patients and life goes on. And they look good for their investors.”
Something is wrong when $34 billion in profits is considered insufficient!
I have UHC insurance through my Medicare Advantage plan. It is a plan for people with chronic conditions. I was recently notified that as of October 1 that they would no longer be including Ascension Medical Group in their network. Unless Ascension negotiates a new contract with them, my PCP and my cardiologist would be considered out of network and more expensive for me to see if I remained with UHC. I have been with these doctors for over 13 years and they have treated me through some serious situations. I trust them and they are familiar with my issues. I am seriously considering dropping UHC and shopping for a new carrier during the open enrollment period starting on 10/15/2025.
I just got a letter from Ascension telling me that if I want to stay with my doctors I can by switching to another carrier and they gave me a list of carriers to contact. This is all such a bunch of stress that I do not need in this current environment that we are all living in. I am not wanting to be with a carrier that puts their patient's lives last on their priority list.
We need universal health care in this country. Medicare for All is looking better every day.