Medicare Advantage has many restrictions, and patients struggle when they must switch doctors

[Duaine]

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

 

[somarco]

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.

I am baffled that agents who (claim) to have a thousand+ clients have NEVER encountered anything like this.

This can very well happen when your providers are owned by a hospital and that hospital recently broke up with a carrier.

 

[Chazm]

I am baffled that agents who (claim) to have a thousand+ clients have NEVER encountered anything like this.

This can very well happen when your providers are owned by a hospital and that hospital recently broke up with a carrier.

Any reputable agent that offers MAPD knows that there are restrictions. I tell every single person that I talk to, “here are the issues that you could deal with if you end up choosing a MAPD.”

50% still choose that route. I put it in my notes and i carry on. It’s my job to explain the pros and cons of Medicare advantage versus Medicare supplement. It’s their job to make that decision.

 

[InsuranceGuy29]

Oh look, another sensationalist MA hit piece. Sometimes networks change for Medicare Advantage. BREAKING NEWS! Call the police!

If the hospital (who is a private business, like any other) really cared, they would try to come to a deal, but they always play the "holier than thou" role.

They're just as much at fault as anyone else. This is also not a "new and unique challenge." I'm not sure if this lady is huffing paint, but this sometimes happens, and has always happened.

All the person will need to do it find another insurer that has the hospital in-network. Very simple.

Literally everyone in the country has health insurance that sometimes changes networks and such until they're on Medicare. But for some reason, as soon as you get on Medicare and it happens, it's worthy of the same outrage as unaliving a baby in the middle of the street. These sensationalist pieces have gotten to ridiculously laughable levels.

Hospitals just don't like MA because they question them and their (many times) fraudulent practices. That's the real truth. Google "Medicare fraud hospital, "click on "news," and go see for yourself. They love original Medicare because there is no one policing it.

Also needs to be noted that United is staying in-network. See: "CORRECTION: Loyola Medicine and UnitedHealthcare reached an agreement June 28 to keep Loyola in-network. The patient below no longer is in danger of losing in-network access at Loyola."

 

[straightnochaser]

Oh look, another sensationalist MA hit piece. Sometimes networks change for Medicare Advantage. BREAKING NEWS! Call the police!

If the hospital (who is a private business, like any other) really cared, they would try to come to a deal, but they always play the "holier than thou" role.

They're just as much at fault as anyone else. This is also not a "new and unique challenge." I'm not sure if this lady is huffing paint, but this sometimes happens, and has always happened.

All the person will need to do it find another insurer that has the hospital in-network. Very simple.

Everyone has health insurance that sometimes changes networks and such until they're on Medicare, but for some reason, as soon as you get on Medicare and it happens it's worthy of the same outrage as unaliving a baby in the middle of the street. These sensationalist pieces have gotten to ridiculously laughable levels.

Hospitals just don't like MA because they question them and their (many times) fraudulent practices. That's the real truth. Google "Medicare fraud hospital" and go see for yourself. They love original Medicare because there is no one policing it.

Also needs to be noted that United is staying in-network. See: "CORRECTION: Loyola Medicine and UnitedHealthcare reached an agreement June 28 to keep Loyola in-network. The patient below no longer is in danger of losing in-network access at Loyola."

Imagine copying and sharing the article but leaving that portion (at the top of the article) out.

 

[somarco]

@Chazm I know your reading skills are keen, but my post was not about comparing Medigap to MAPD during the sales process.Nor did I suggest agents were not forthcoming in explaining how managed care works.

Rather, my comment was about the apparent lack of communication between the policyholder and writing agent when providers are no longer in network.

Either the policyholder is so well informed about the intricacies of managed care, they have total recall of the sales presentation and thus, are not surprised when they have to find a new par provider, or they have no confidence the writing agent and don't believe that agent can help.

So many agents claim there are never any complaints from policyholders as long as they don't have to pay a premium.

I suppose there is another possibility in the case of the lost provider. Perhaps these things never happen and all the reports like this are chalked up as fake news.

 

[rmhaire]

So many agents claim there are never any complaints from policyholders as long as they don't have to pay a premium.

And some of them are telling the truth.

I started selling supplements in 1989. Everything was F2F back then because Al Gore hadn't finished inventing the internet yet.

I lost count of the appointments I went on where another agent had been there before me. I called those agents fly-by's. They would blow into town, hit up all the T-65s and would never be seen or heard from again.

The same thing is happening today but on a much larger scale. The hottest thing in insurance today is MA and MAPD. Just look at all the recruiters on YouTube or Face Book. I call them pimps. When was the last time you saw one pushing supplements?

Add all the new call center agents that are nothing more than fly-by's with an internet connection and you've got tons of agents that have never had a complaint call.

 

[vic120]

Oh look, another sensationalist MA hit piece. Sometimes networks change for Medicare Advantage. BREAKING NEWS! Call the police!

If the hospital (who is a private business, like any other) really cared, they would try to come to a deal, but they always play the "holier than thou" role.

They're just as much at fault as anyone else. This is also not a "new and unique challenge." I'm not sure if this lady is huffing paint, but this sometimes happens, and has always happened.

All the person will need to do it find another insurer that has the hospital in-network. Very simple.

Literally everyone in the country has health insurance that sometimes changes networks and such until they're on Medicare, but for some reason, as soon as you get on Medicare and it happens it's worthy of the same outrage as unaliving a baby in the middle of the street. These sensationalist pieces have gotten to ridiculously laughable levels.

Hospitals just don't like MA because they question them and their (many times) fraudulent practices. That's the real truth. Google "Medicare fraud hospital" and go see for yourself. They love original Medicare because there is no one policing it.

Also needs to be noted that United is staying in-network. See: "CORRECTION: Loyola Medicine and UnitedHealthcare reached an agreement June 28 to keep Loyola in-network. The patient below no longer is in danger of losing in-network access at Loyola."

Now wait a minuet most are NOT educated that this can happen, Many who I speak to had spoken to agents before who only gave them the rose colored side of the picture

Unless explained no one see's it coming

And even when it is explained they wont like it, would you?
Many who go to MA cant afford the supplement,
and most go through checking every doctor that is important to them prior, as well

In fact if a client says you did not check their Doc and you have no proof The carrier will take it very seriously

Its not like they can always legitimately change, yea I lot of people fudge SEPs
but that is not legitimate

If my ins on the marketplace droped my sons caretakers
this would be a big deal to have to wait till the end of the year, to make a change

Yes it is a reality but its not ok, this does not make it right

If they are going to restrict EP, then network changes should be restricted to the same time periods

 

[somarco]

@rmhaire the problem is not the product but more about the way it is marketed by mostly untrained agents who are trained to grab the brass ring and move on to the next fish.

I get calls, and you do as well, from folks who do not understand what they bought and eventually found out the plan was not the same as what they were sold. They also want to get out of their plan as quickly as possible but it rarely happens as easily as they want or need.

There is too much money to be made ethically without having to paint a picture of a plan where everything is covered.

I know it is impossible to explain every possible challenge that can occur. That is true regardless of the product that is sold.

But I also know the buyer tends to focus on the good stuff and disregards the bad.

 

[LostDollar]

"the problem is not the product but more about the way it is marketed by .... "

Caveat, I am not an agent.

I have not read the rest of this thread, just came to the quoted last post from site recent post notifications.

I have had 6 years of exposure here to "discussions" about Medicare health insurance products, including comments about both their features and how they are marketed.

I have recently had need to attempt to obtain some level of understanding about Life Insurance (at the FE level) and Annuities, from the perspective of a consumer desiring to purchase a policy and a contract.

I think the same things one might say about agents in the Medicare field could also be said about agents in the Life Insurance and Annuity fields.

HOWEVER, I think discussion about marketing practices for Medicare Products, Life Insurance, and Annuities should also extend to actions of the Insurance Carriers and the way they present BOTH themselves and their products to BOTH agents and consumers.