Hospitals Are Dropping Medicare Advantage Plans!
Why and Who?
By Barbara Carey and Mike McCall
The most common reasons hospitals and medical clinics all over the country are dropping Medicare Advantage Plans are EXCESSIVE PREAUTHORIZATION REQUIREMENTS AND DENIALS COUPLED WITH
SLOW PAYMENTS FROM INSURERS, according to Becker's Review, Chris Van Gorder, President and CEO of Scripps Health said, “It’s become a game of delay, deny and not pay.”
Every hospital and clinic administrator in the country is familiar with these two reasons and their staffs and physicians deal with these issues on a daily basis. A hospital has higher costs and slower pay with frequent denials for tests and procedures with patients covered by Medicare Advantage Plans. Some large systems like Scripps are experiencing heavy losses due to this system. So, if your hospital is experiencing these issues, you are not alone.
However, patients over 65 are constantly being encouraged through advertising, informercials and celebrities to join Medicare Advantage Plans. These patients need to know that they have a choice. They can stay with Original Medicare and most seniors do not know that fact.
As TCI has said in previous articles, hospitals can no longer sit on the sidelines and not educate their patients on the disadvantages of these plans and the lack of access to healthcare providers that they have. No free vision service is worth giving up your primary care provider or paying more to see that provider because they are not in your plan’s Medicare Advantage Network. Patients should think carefully about giving up their right to choose theirprovider as they can in Original Medicare.
TCI has a “ready to use” FACT SHEET and Presentation that you can use to educate your patients. We are the experts at direct Healthcare to Consumer (H to C) communication.
Consumers are smart and need information to make good decisions. They need to know that Medicare Advantage companies are “for profit” companies and Medicare pays them a citizen’s share of Original Medicare to give back to patients for their medical needs. However, the fewer payments Medicare Advantage Plans make to providers the higher their profits. There is an incentive to restrict care built into the system. The system in all fairness has an incentive to work on preventative care. However, if a senior already has chronic disease and other significant conditions requiring complex
care, they will have to fight through approvals and denials to receive the care that they need. Most patients do not know this fact when they select a Medicare Advantage Plan.
These are some of the hospitals according to Becker's Healthcare Review that have recently discontinued accepting various Medicare Advantage Plans:
WellSpan Health - York, PA ECU Health - Greenville, NC WakeMed - Raleigh, NC
Genesis Healthcare System - Zanesville, OH Southeast Georgia Health System - Brunswick, GA Vanderbilt Health - Nashville, TN
Cape Fear Valley - Fayetteville, NC Samaritan Health Services - Corvallis, OR
Cameron Regional Medical Center - Cameron, MO Stillwater Medical Center - Stillwater, OK Brookings Health Center - Brookings, SD
Baptist Health Medical Group - Louisville, KY
Healthcare Leaders...Call or email TCI for information and pricing on our Medicare Information Tool Kit and start building the knowledge of your patients, not for just this Medicare enrollment period but throughout the year!
We Help Our Clients Understand Their Environment and to Find Solutions.
Call Us 1-888-922-2824 or Email barbara@tciconsults.com
