Medicare Advantage Plans To Be Squeezed Next Year, Reduce Benefits

[goillini52]

We're trying out MAPD this year. I haven't had any complaints until Friday.

Around 4 in the afternoon, I get an email from my wife's Cardiologist canceling her appointment , which was supposed to be yesterday, because he's no longer in network. One days notice. I called them and after 20 minutes on hold, they confirmed that they wouldn't see her since they're no longer in network. I finally got them to renew her prescriptions for 90 days to give us time to find a new Cardiologist.

I called Aetna and confirmed that he's no longer in network, but he was still on Aetna's site. Aetna has a great network. Every doctor and hospital within 75 miles of me was in network...was.

Making me think about going back to Med Supp. I don't like networks. I just wanted to try the MAPD since I sell it.

 

[Russ]

We're trying out MAPD this year. I haven't had any complaints until Friday.

Around 4 in the afternoon, I get an email from my wife's Cardiologist canceling her appointment , which was supposed to be yesterday, because he's no longer in network. One days notice. I called them and after 20 minutes on hold, they confirmed that they wouldn't see her since they're no longer in network. I finally got them to renew her prescriptions for 90 days to give us time to find a new Cardiologist.

I called Aetna and confirmed that he's no longer in network, but he was still on Aetna's site. Aetna has a great network. Every doctor and hospital within 75 miles of me was in network...was.

Making me think about going back to Med Supp. I don't like networks. I just wanted to try the MAPD since I sell it.

HMO plan or PPO?

 

[goillini52]

HMO plan or PPO?

PPO

 

[Fisher]

Making me think about going back to Med Supp. I don't like networks.

Networks, along with prior auth bullshit, is the bad taste I get in my mouth from managed care.

 

[DonP]

PPO

Why wouldn’t they bill out of network ? I’ve rarely ever seen a dr not bill out of network . There getting paid their fee .I listened to podcast from fmo today . He thinks pdp prices triple . Big changes for all Medicare people . If Biden didn’t forgive $200 bil of student lones we’d have seen no changes

 

[Northeast Agent]

nP said:

Why wouldn’t they bill out of network?

I've dealt with this before with both Aetna and Humana. The doctors offices dropped both midyear, as they said they paid too slowly.

 

[Special Agent]

Why wouldn’t they bill out of network ? I’ve rarely ever seen a dr not bill out of network . There getting paid their fee .I listened to podcast from fmo today . He thinks pdp prices triple . Big changes for all Medicare people . If Biden didn’t forgive $200 bil of student lones we’d have seen no changes

I have often called out of network providers to ask if they would still see an existing patient OON and be told no only to find out later they accepted it.The providers that are usually a hard NO are the ones who do not have a contract with any of the carriers other plans ie EGHP,ACA,Medicaid etc

 

[DonP]

nP said:

Why wouldn’t they bill out of network?

I've dealt with this before with both Aetna and Humana. The doctors offices dropped both midyear, as they said they paid too slowly.

I’ve seen it rarely so far but I expect to see it much more going forward . Wait till you see the fights between carriers trying to save money and the hospital systems boil over . It’s going to get ugly and very personal . So your correct the drs and hospitals could refuse to bill out of network

 

[goillini52]

Why wouldn’t they bill out of network ? I’ve rarely ever seen a dr not bill out of network . There getting paid their fee .I listened to podcast from fmo today . He thinks pdp prices triple . Big changes for all Medicare people . If Biden didn’t forgive $200 bil of student lones we’d have seen no changes

I just decided that if they'd do that with 1 days notice, it's a good time to switch Cardiologists. Easier to switch than go through the hassle. My wife doesn't like to go, but has to to get the meds. Since they wrote her 90 day scripts, we've got time to find another one. Not a big deal...plenty to choose from.

 

[somarco]

I called Aetna and confirmed that he's no longer in network, but he was still on Aetna's site. Aetna has a great network. Every doctor and hospital within 75 miles of me was in network...was.

Odd to drop out mid month. Provider MCO contracts usually don't run on a calendar year and can expire at any time . . . but usually at the end of the month.

Websites are rarely accurate . . . especially carrier sites . . . provider site usually more current.

If you go out of network you can expect the claim to be routed through Multiplan . . . and then you get hosed.

. Every doctor and hospital within 75 miles of me was in network...was.
Are you saying every provider near you is no longer in network with your Aetna plan?


There may be times when you decide to visit a doctor or hospital not in the Aetna network. Some plans cover out-of-network care only in an emergency — otherwise, you are responsible for the full cost. For plans that do cover out-of-network care, you'll usually pay more than if you stayed in the network.

https://www.aetna.com/individuals-families/using-your-aetna-benefits/network-out-of-network-care/cost-of-out-of-network-doctors-hospitals.html

MultiPlan is in the legal crosshairs of another healthcare system over contracts and services provided to partner health plans that providers have described as collusive and anticompetitive.

The class-action complaint was filed last week in an Illinois district court by Allegiance Health Management, a Louisiana-based for-profit with more than a dozen hospitals that said it and others have suffered “massive economic losses” due to the practices.

The class action also names several major payers that work with MultiPlan to negotiate out-of-network bills with providers as co-defendants: CVS Health’s Aetna, Elevance Health, UnitedHealth Group, Centene, Humana and integrated health network Kaiser Permanente.

MultiPlan, major payers again accused of conspiring to limit provider reimbursement

MultiPlan is in the legal crosshairs of another healthcare system over contracts and services provided to partner health plans that providers have described as collusive and anticompetitive. | Allegiance Health Management is the latest provider organization to come out against MultiPlan's...

www.fiercehealthcare.com