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A doctor at Loyola Medicine worries about a longtime patient forced to find a new in-network health care system to treat life-altering illnesses.
“I want to make it clear this will be an involuntary separation.”Her tone was in jest, but her eyes were pure weariness as she sat in my office, wringing her hands and doing her best to fight back tears.
“Pain is something I can deal with. Finding an entire new team of doctors is not,” she said as she shook her head.
If you had passed her in the waiting room, she would’ve struck you as a woman of pure poise — her hair neatly placed, her blouse tucked in and beige shoes matching her purse. Her appearance belied her inner strength and resilience. Sharon is in her 70s and has known pain most of her adult life. She was diagnosed with rheumatoid arthritis at a young age and has had numerous complications and flares. Her inflammatory disease isn’t just limited to her joints. It has contributed to complications including coronary heart disease and chronic lung disease. She recently gave up driving.
However, like many of my patients, the medical exam isn’t the hard part about coming to see me; it’s all the things that come with it: navigating health systems and co-pays, phone calls and parking fees, deductibles, networks and insurance coverage gaps known as “donut” holes.
Opinion
And now she is being asked to navigate something entirely unexpected: Her Medicare Advantage plan will soon list my health system as “out of network.” She will need to find a new primary care doctor, rheumatologist and cardiologist. She’s been with our team for more than 10 years and is now being asked to make a change.“Do you even know where the next closest rheumatologist is?” she asked me, still shaking her head.
Sharon isn’t alone; she’s among thousands in my system who will be affected once United Health no longer contracts with my hospital. While younger patients on commercial plans might not be surprised by network changes, something that frequently comes with the territory of having private insurance in America, this is a new and unique challenge for seniors.
[EXTERNAL LINK] - Medicare Advantage has many restrictions, and patients struggle when they must switch doctors
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