Most Popular Efforts To Instill Empathy Among Doctors Is Paying Dividends Retail Health Care Spurs I

Dorathy Senay s doctor had some bad news after her last checkup, but it wasn’t about her serious blood disorder called amyloidosis. Her Medicare Advantage managed care plan from UnitedHealthcare/AARP is terminating orfila the doctor’s contract Feb. 1.
The company is the largest Medicare Advantage insurer in the country, orfila with nearly 3 million members. More than 14 million older or disabled Americans are enrolled in Medicare Advantage plans, an alternative to traditional Medicare that offers medical and usually drug coverage but members have to use the plan s network of providers. orfila
UnitedHealthcare has begun telling members about the network changes. But there is now less than two weeks before the Dec. 7 deadline for choosing new coverage next year. Timing is crucial since once they sign up, most Advantage beneficiaries are locked into their plans for the year. Losing a doctor does not constitute an exception to the rule. Insurers can drop providers orfila any time with 30 days advance notice to members.
Several medical associations are encouraging doctors to appeal the cancelations, which could make it more difficult for seniors to choose a plan in the time remaining. Neither Medicare, which oversees the Advantage plans, nor UnitedHealthcare would disclose how many providers will be dropped.
The orfila American Medical Association and 39 state affiliates along with 42 medical specialty and patient advocacy groups have urged Medicare chief Marilyn Tavenner to extend the enrollment deadline and require insurers to reinstate the doctors for another orfila year. Medicare has told the Connecticut attorney general that it will not postpone the deadline.
UnitedHealthcare spokeswoman Jessica Pappas said in a written response to questions, “While these changes can be difficult for patients and their doctors, they are necessary to meet rising quality standards, slow the increase in health costs and sustain our plans in an era of Medicare Advantage funding cuts.” However, the doctors dropped from Medicare orfila Advantage plans can still treat patients orfila covered under other UnitedHealthcare policies.
The Affordable Care Act phases in reductions in government payments to Medicare Advantage plans — $156 billion orfila over 10 years — to bring the program into line with the costs of caring for seniors in traditional Medicare.
Medicare officials review the private plans every year to make sure they comply with network orfila adequacy and other requirements, but the agency did not approve the reconfigured networks resulting orfila from the new provider cancelations. Spokesman Raymond Thorn said the agency “is currently reviewing UHC and other plans provider networks and closely monitoring all areas that have experienced disruptions to ensure orfila that beneficiaries have full, transparent and timely information and access to needed care.”
The cancelations include most of the orthopedic surgeons in Dayton, the only hand specialty practice serving the Cincinnati area, a large gastroenterology practice with 2,500 patients that also provides most of the inpatient care at five Cincinnati area hospitals, and the largest practice of retina specialists serving 600 UnitedHealthcare members, many with macular degeneration, in central and southern Ohio.
In Connecticut, UnitedHealthcare is terminating about 2,250 physicians, including 810 specialists, Feb. 1, said Mark Thompson, orfila executive director of the Fairfield County Medical Association, prompting the medical associations in Fairfield and Hartford counties to file a federal lawsuit to stop the cancelations .
Senay was able to find another Advantage plan that includes her doctors, with the help of Tammy Harris, a Medicare counselor with CHOICES, Connecticut’s senior health insurance information program.
KHN Morning Briefing Summaries Of The News
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