Ever Heard of a Medical Group IMMEDIATELY Terminating a Carrier

[wehotex]

I just got word today that a major medical group in my city terminated its Aetna MAPD members immediately (as in yesterday). There was no warning, no letter that went out to the members and no grace period. This particular clinic has pulled this stunt before when it ousted its 90% Humana MAPD membership. But even in that situation, it gave its patients a letter advising that they had 4-5 months to make other arrangements. When the Clinic people figured out that they were giving the patients too much time, they shortened it to 1 month and steered all of the patients into United Health, their preferred carrier. I really didn't know that a provider could cut off services so abruptly. Has anyone ever seen anything like this?
I'm glad that I had only put 1 customer into their group with Aetna. But, it makes me wonder if they'll come after my Amerigroup members next?

 

[kgmom219]

I just got word today that a major medical group in my city terminated its Aetna MAPD members immediately (as in yesterday). There was no warning, no letter that went out to the members and no grace period. This particular clinic has pulled this stunt before when it ousted its 90% Humana MAPD membership. But even in that situation, it gave its patients a letter advising that they had 4-5 months to make other arrangements. When the Clinic people figured out that they were giving the patients too much time, they shortened it to 1 month and steered all of the patients into United Health, their preferred carrier. I really didn't know that a provider could cut off services so abruptly. Has anyone ever seen anything like this?
I'm glad that I had only put 1 customer into their group with Aetna. But, it makes me wonder if they'll come after my Amerigroup members next?

Hmmm....something doesn't add up

The contract with Aetna should be end of month. Assuming its a capitation agreement, they should still be getting paid on their membership through 10/31. And the members can't change PCPs until 11/1.

So any Aetna people don't have a PCP til 11/1?

Uhhh...no.

There's a missing piece to the puzzle. Not sure what it is, though.

1. Call TDI. There's got to be a requirement for notification
2. There is NO way CMS allows this. Report it.
3. Tell your client to rate the clinic at 1 star.

 

[wehotex]

Hmmm....something doesn't add up

The contract with Aetna should be end of month. Assuming its a capitation agreement, they should still be getting paid on their membership through 10/31. And the members can't change PCPs until 11/1.

So any Aetna people don't have a PCP til 11/1?

Uhhh...no.

There's a missing piece to the puzzle. Not sure what it is, though.

1. Call TDI. There's got to be a requirement for notification
2. There is NO way CMS allows this. Report it.
3. Tell your client to rate the clinic at 1 star.

Yes, thanks. I only heard about it when I was completing my paperwork. When I called the Clinic, I only asked about Amerigroup. It is one of those clinics that has sales agents that churn business 24/7, so I generally try to avoid placing any customers with them. By a miracle, the marketing guy just clarified with me that they will see them until Dec 31. Unfortunately, the office staff there always encourages the patients to go into the break room to talk with the churners.

 

[kgmom219]

Yes, thanks. I only heard about it when I was completing my paperwork. When I called the Clinic, I only asked about Amerigroup. It is one of those clinics that has sales agents that churn business 24/7, so I generally try to avoid placing any customers with them. By a miracle, the marketing guy just clarified with me that they will see them until Dec 31. Unfortunately, the office staff there always encourages the patients to go into the break room to talk with the churners.

Good.

Leaving people without a PCP is total crap. Glad they can see someone!