It's happening, doctor opting out of Medicare

[MedicareAgent]

If a dr. drops om they cannot take an advantage plan, rethink that op

 

[axeman462]

If a dr. drops om they cannot take an advantage plan, rethink that op

I don't know exactly what is happening with these providers, I suppose it is possible that the doctors are not actually opting out of Medicare, but it is possible that they are not longer accepting it as a payment.

I just know that this is the 3rd time in the past year that a customer has come to me and told me that their doctor is not accepting Original Medicare anymore. And each time I called the office to confirm (because I was convinced each time that the customer was confused), the office confirmed that "they are no longer accepting Original Medicare as payment." But they would accept certain MAPD plans.

take it however you want, but I'm trying to give the brokers on this forum a heads up of what is coming down the pike. Medicare reimbursements have gotten to the point where doctors have to make some tough decisions.

 

[MedicareAgent]

Wow ! I have not heard this before but wicked interesting how that works.

 

[AgentGeneral]

I don't always know the rhyme or reason why docs do what they do. But I do ask them and the last answer i got when a doc had Aetna in their network, then opted out for the upcoming year, I asked. It's easy enough always for me to just call up the facility and take 5 minutes to have a better understanding.

When I asked this time, the whole reason it came up is bc I know even though a doc takes a carrier or plan one year, doesn't mean it will the next. I called when I was about to enroll a lady in Aetna. I knew the doc took it the one year, but wasn't sure about the next. They said no, not for 2023. I asked why and the reason was simple for that facility. She said, not many patients at that particular facility were on Aetna and it cost them money to "credential" so they opted out. The majority of their patients were on BCBS, Priority, Humana, so they were still accepting those. Simple answer, and I was sure there might be more to it, but sounded good enough to me. Ok, BCBS it was.....

When I want to know why, I just call them and ask. So, maybe you should call em up and simply ask. Billing depts are good places to start, although not the only option.

 

[AgentGeneral]

Adding--I know it's not the same as the OP posted. BUT, I like to just dig a little and find out why something was changed. OR why it's changing. It's never bc a doc doesn't like one over the other, it's a business decision that works best for them.

I was though under the impression that if they accept MAPD that they were supposed to accept medicare in general. I could be wrong....and if so, I'd own it.

 

[axeman462]

Adding--I know it's not the same as the OP posted. BUT, I like to just dig a little and find out why something was changed. OR why it's changing. It's never bc a doc doesn't like one over the other, it's a business decision that works best for them.

I was though under the impression that if they accept MAPD that they were supposed to accept medicare in general. I could be wrong....and if so, I'd own it.

Alright, so after reading your post, I decided to call the doctor offices that I knew opted out recently, but are still accepting MAPD.


First, what you were saying about the doctors must accept OM if they are accepting MAPD, Yes, that is true, in theory.

But what I have experienced here in Florida a few times now over the past year, mostly the past 6 months or so, and I confirmed with the phone calls to these doctor offices is that some doctors are not accepting OM for new patients.

These 3 office, did not actually Opt Out of Medicare, they are just weaning themselves off OM.

Here are a few bullet points I took from the conversations. One of the offices was very forthcoming. It almost felt like they wanted to educated the public on what was happening in their industry, and I encourage y’all to share the word, because I believe this will affect our industry in the coming years:

• Physician payments from Original Medicare have not kept up with inflation over the past 20 years, and it is getting harder for many doctor offices to keep the doors open.
• This particular office gave me a few specific examples:
  • Florida Blue 2023
    • $94,300 in charges, $73,500 in receipts, $20,800 in adjustments.
    • She says they are making an average of 23cents on every dollar of receipts
  • UHC 2023
    • $155,000 in charges, $124,000 in receipts, $31,000 in adjustments
    • They make an average of 38cents on every dollar of receipts
  • Original Medicare
    • $260,000 in charges, $163,800 in receipts, $96,200 in adjustments
    • They lose 31 cents on every dollar of receipts due to overhead related to OM regulations
• The extra red tape from Medicare causes the physicians to spend less time with the patient, and therefore, lower quality healthcare. It is the doctor's wish to provide only the highest quality service to the patients.

So here’s what happened with the customers.

The one in Tampa, is actually a potential new customer of mine. Had an MAPD, but switched to OM with a medsupp back in the Fall, after another agent promised her the world. Her doctor won’t see her now, because in his eyes, she is a new OM customer. His office does not want more OM customers.

The customer that started this thread, their doctor office (although they wouldn’t admit on the phone), seems to be encouraging patients to leave OM and either join their “private contract” or a PPO.

I'm not saying that this is the end of the world, or that OM is be no more. What I am saying is that the gravy train might be slowing down, and that the changes that must come to Medicare in the coming years, will create a real need for good Medicare brokers.

 

[rmhaire]

But what I have experienced here in Florida a few times now over the past year, mostly the past 6 months or so, and I confirmed with the phone calls to these doctor offices is that some doctors are not accepting OM for new patients.

Just the opposite in South GA. I've made the same phone calls and it's MA that they're not taking new patients on. OM has been no problem.

 

[Truce]

Thanks for calling the offices and sharing their feedback.

As far as Medicare red tape creating unsustainable overhead, can you explain (can they explain?) what that means to a physician office in a way that would be unique and isolated to OM compared to MA?

I believe I have heard the humana rep saying docs who billed via MAPD PPO would get 120% of Medicare rates contractually for office visits...is that correct, and consistent accross other MAPD carriers?

I am definitely concerned about my clients losing access to doctors because OM reimbursement is so low. I used to think the sheer volume of OM members and less hassle for reimbursement would offset the lower rates, at least from a provider perspective.

 

[axeman462]

Just the opposite in South GA. I've made the same phone calls and it's MA that they're not taking new patients on. OM has been no problem.

A fool's way is right in his own eyes,
but whoever listens to counsel is wise.

 

[rousemark]

A fool's way is right in his own eyes,
but whoever listens to counsel is wise.

Not sure what you mean by this reply to Robrert's statement that in South GA doctors are encoraging OM over MA. I know in my area of East Tennesse that is also the case. I was considering changing to an MA and all my doctors advised my keeping OM and my supplement.