Re: Sample Beneficiary Letter for Physicians Terminated from Network. Dear Physician,

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1 Re: Sample Beneficiary Letter for Physicians Terminated from Network Dear Physician, Thank you for reaching out to the AADA regarding your termination from a Medicare Advantage network. We believe it is important for you to appeal your denial, but also to request your affected patients contact CMS regarding your termination to ensure CMS is aware of the impact that your removal from network has on patients. While CMS is unable to require an insurance company to include a specific physician in-network, it can require that a minimum number of providers are included in a network. For CMS to become involved in a termination process they need to hear from beneficiaries that network terminations are impacting their access to care. Once a patient has written the letter we encourage the patient to send a copy of the letter to their members of Congress, their physician, and the AADA at dbrewster@aad.org. Please note - no patients will be contacted by the AADA without prior authorization from the physician. The impacted physician should retain a copy of the letter to include with their termination appeal to the insurance company. Sincerely, Brett Coldiron, MD, FAAD President,

2 AADA suggestions that an impacted patient may want to consider including in a comment letter: I. Heading and Salutation: Re: Physician Terminated from UnitedHealthcare/Humana Medicare Advantage Network Dear Sir/Madam: II. III. Introduction: Introduce yourself (your name, where you live) Explain why you are writing this letter: I am writing to share my concerns and disappointment that my <dermatologist / skin cancer surgeon>, <John Smith, MD> has been removed from my Medicare Advantage network. I fear that <his/her> removal will limit my access to specialized <skin / skin cancer> care by requiring me to try to find a new <dermatologist/ Mohs surgeon> in a narrower network of physicians. IV. Tell your story and your history of care with the physician I was diagnosed with Melanoma [at what age, explain what living with your disease is like] My treatment includes Mohs surgery [Explain the best that you can how extensive your treatment has been, what benefits you ve had from the treatments, how level of care provided has impacted your life] V. Explain your concerns about your physician s removal from network I am concerned that with the termination from the network of Dr. <name> I will need to find a new physician that does not know my healthcare history and this could delay my access to much needed care. Throughout my time with this office I have developed a trusted relationship with him/her.

3 VI. Conclusion Ask CMS to request the insurance company review the network s adequacy, the reason for the physician s termination and thank them. I am concerned that with the termination from network of <Dr. Smith>, I will need to find a new physician that does not know my medical history and special healthcare needs and may not have the expertise to treat my <disease>. Additionally, it is my understanding that numerous dermatologists have been removed from my insurer s Medicare Advantage network. This could severely limit my and other patients access to much needed skin specialist care through long delays in getting an appointment and extended travel times. Most importantly, however, over my <X> years as a patient of <Dr. Smith>, I have developed a trusted relationship with <him/her> which cannot easily be replaced. For these reasons, I strongly urge you to request that <UnitedHealthcare/Humana> re-evaluate the termination of <Dr. Smith> and ensure that <UnitedHealthcare/Humana> have adequate access to dermatologists with expertise in <disease> in my Medicare Advantage network. Thank you for your consideration of my comments. VII. Signature How to submit the comments: Comment letters may be sent via mail to: Centers for Medicare and Medicaid Services (CMS) Send a copy of the letter to: Member of Congress United States Senators State Insurance Commissioner dbrewster@aad.org Impacted physician s office

4 July 8, 2014 Patient Name Patient Address Patient Address 2 City, State, Zip Re: Physician Terminated from <UnitedHealthcare/Humana> Medicare Advantage Network To Whom It May Concern, Introduction I am writing to share my concerns and disappointment that my <dermatologist / skin cancer surgeon>, <John Smith, MD> has been removed from my Medicare Advantage network. I fear that <his/her> removal will limit my access to specialized <skin / skin cancer> care by requiring me to try to find a new <dermatologist/ Mohs surgeon> in a narrower network of physicians. Tell your story. Expand the narrative. Below are examples of typical stories. Example: Over the past 10 years, I have developed 15 skin cancers. Dr. Smith has been instrumental in the early diagnosis of my cancers and coordinating the surgical treatments of these cancers. Without Dr. Smith s care, I am certain I would have either died of my cancers or been terribly deformed. Example: In 2006, I was diagnosed by Dr. Smith with malignant melanoma, one of the most deadly forms of skin cancer. Utilizing advanced surgical techniques, Dr. Smith was able to remove the cancer completely and reconstruct the resulting defect. I have been under his care to monitor for new melanomas since then. I owe my life to Dr. Smith s care and skill. Example: I have suffered with psoriasis for 40 years. This disease results in painful and itchy, red scaly areas over my entire body. Prior to meeting Dr. Smith, my quality of life with psoriasis was extremely poor. I never wanted to visit friends because of the dead skin I left behind or go to the beach because of all the stares and questions from strangers. Under the expert care of Dr. Smith, my psoriasis is in remission and I am able to lead a normal life.

5 Example: I am a survivor of numerous skin cancers of the skin including 8 aggressive squamous cell carcinomas on my head and neck over the last 5 years. Dr. Smith is a fellowship trained skin cancer surgeon and expert in cutaneous surgical oncology. He has treated my skin cancers utilizing Mohs micrographic surgery to ensure that the cancers were fully removed while preserving normal tissue. Having been a farmer with heavy sun exposure, it is likely I will develop more skin cancers and need the specialized care that Dr. Smith provides. Example: I was diagnosed with atopic dermatitis when I was 50 years old and have suffered with the severe itching of this condition for years. My quality of life before becoming a patient of Dr. Smith was poor, being unable to carry on my daily activities or sleep well because of the itching. Under Dr. Smith s care, utilizing advanced treatments, my dermatitis is under control and I have my life back. Conclusion I am concerned that with the termination from network of <Dr. Smith>, I will need to find a new physician that does not know my medial history and special healthcare needs and may not have the expertise to treat my <disease>. Additionally, it is my understanding that numerous dermatologists have been removed from my insurer s Medicare Advantage network. This could severely limit my and other patients access to much needed skin specialist care through long delays in getting an appointment and extended travel times. Most importantly, however, over my <X> years as a patient of <Dr. Smith>, I have developed a trusted relationship with <him/her> which cannot easily be replaced. For these reasons, I strongly urge you to request <UnitedHealthcare/Humana> that re-evaluate the termination of <Dr. Smith> and ensure that <UnitedHealthcare/Humana> have adequate access to dermatologists with expertise in <disease> in my Medicare Advantage network. Thank you for your consideration of my comments. Sincerely, <Patient Name> cc: Senator <First Name> <Last Name> Senator <First Name> <Last Name> Congressman <First Name> <Last Name> Insurance Commissioner <First Name> <Last Name>