5,000 Medicare patients say they suddenly lost access to their doctors

[sshafran]

will the potential care disruption issues experienced with MAPD's be eliminated with the MSA MA plans that have recently been discussed in other threads?

No.

 

[sshafran]

It depends . . .

But there is a big difference in a doctor making the decision, the patient making the decision, and the CARRIER making the decision for the patient.

UHC said ARC made the decision; “UHC said, “We are disappointed with ARC’s decision to end its participation in our network. Our top priority is ensuring our members transition smoothly and have continued access to the care they need.””

 

[sshafran]

I’ve already seen a YouTube video on this that smells clickbaitish.

I guess if you really enjoy selling this way, you make videos of rare situations like this as quasi scare tactics (even using an article which is clearly not that well written / researched).

 

[LostDollar]

UHC said ARC made the decision; “UHC said, “We are disappointed with ARC’s decision to end its participation in our network. Our top priority is ensuring our members transition smoothly and have continued access to the care they need.””

The article said it was a mutual decision that the contract would end.
The article said that UHC told the reporting organization that providers remained in network and were available through the end of the year.
The article further said that UHC communicated different information to a plan participant, saying the participant had to change doctors Oct 1 rather than Jan 1. That is carrier management of participant healthcare.

And it is likely the carrier tried to force the hospital into unpalatable financial concessions.

 

[sshafran]

The article said it was a mutual decision that the contract would end.
The article said that UHC told the reporting organization that providers remained in network and were available through the end of the year.
The article further said that UHC communicated different information to a plan participant, saying the participant had to change doctors Oct 1 rather than Jan 1. That is carrier management of participant healthcare.

Not to put my tin foil hat on, but did you notice that the patient “interviewed” just so happened to be a patient of the CEO of ARC?

I don’t believe for a second that the CEO is not frustrated losing thousands of patients in 2019 and somewhat coordinated this “shocking news.”

Providers and Carriers often have public fights - and providers love playing the role of caring doctor against the villain insurance carrier.

It may be a tin foil hat, but sometimes it fits well.

 

[Chazm]

But the article says that UHC is forcing a patient to have a new doctor eff 10/1 even though the UHC / provider agreement says the changes do not happen until the end of the year.

UHC isn’t forcing them. If the doctor says they can no longer see them (by not honoring the agreement) then uhc, which sounds like an hmo has to assign them another pcp.

 

[sshafran]

How many patients do most CEO’s have? lol.

 

[somarco]

No.

Are you sure?

On another note, I will agree that most news reports get half the truth, even when they interview "experts". There is most likely some version of the truth in the story.

EDIT - I found the TV news report including an interview with Mr Cerny. The letter from UHC is also shown. Also interviews the doc and credits him as CEO. FWIW many years ago our PED was recruited by KP to head up their PED department. He continued to see us and other private patients even though we did not have KP coverage.


Losing access to providers IS a real problem with mangled care plans. One former U65 client diagnosed with cancer shortly after she lost her grandfathered plan.

Good news is, she was able to get an Obamacare plan and keep her doctors.

For a year.

The carrier decided to pull out of her county. New carrier had smaller network that did not include her docs.

She is paying full price to keep her docs. No repricing. No deductible credit.

While losing access to specific health care can happen in OM it is more prevalent in mangled care plans.

 

[somarco]

UHC said ARC made the decision; “UHC said, “We are disappointed with ARC’s decision to end its participation in our network. Our top priority is ensuring our members transition smoothly and have continued access to the care they need.””

Each side blames the other.

SOP

Negotiations often break down but most are usually resolved at the last minute. A few may go weeks or maybe even a month past the deadline. Rare when the impasse is such that the parties pick up their marbles and go home.

 

[policywunk]

Are you sure?

On another note, I will agree that most news reports get half the truth, even when they interview "experts". There is most likely some version of the truth in the story.

EDIT - I found the TV news report including an interview with Mr Cerny. The letter from UHC is also shown. Also interviews the doc and credits him as CEO. FWIW many years ago our PED was recruited by KP to head up their PED department. He continued to see us and other private patients even though we did not have KP coverage.


Losing access to providers IS a real problem with mangled care plans. One former U65 client diagnosed with cancer shortly after she lost her grandfathered plan.

Good news is, she was able to get an Obamacare plan and keep her doctors.

For a year.

The carrier decided to pull out of her county. New carrier had smaller network that did not include her docs.

She is paying full price to keep her docs. No repricing. No deductible credit.

While losing access to specific health care can happen in OM it is more prevalent in mangled care plans.

mangled care? haha .Not sales tactics bit scare tactics! I bet you sell alot of cancer policies too!