Why Do Providers Refuse Medicare Advantage Plans?

[somarco]

This is a fairly popular question. Enter "why do some doctors not take medicare advantage plans" and consider the results.

I have my own theories about why some doctors, clinics and hospitals do not participate in managed care plans . . . what is your opinion?

 

[Mr Medicare]

Some doctors, hospitals, and medical groups only accept new patients if they have Medicare Advantage. Sutter in California is one example.

 

[somarco]

Some doctors, hospitals, and medical groups only accept new patients if they have Medicare Advantage. Sutter in California is one example.

Does not address the question posed.

 

[adjusterjack]

Maybe this answers the question.

Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care" (OEI-09-18-00260) (hhs.gov)

 

[vic120]

I used to work with a doc in NY who delt with a lot of condition some had cancer and other things,

there were enough who had lower income and had MA so they took what the needed but def had preferences on which carriers and spoke in leath on other carrier why she would not take them

And its preauth There were certain carriers just would not accept do to blocking treatments same things with prescription

anther thing they really didn't like the Duels many times would ask me to help clients with Medicaid get on PDP to get out of duel plans in order to get treatments

they didn't even like to take the same companies they took reg MA plans from when it came to duels

At least when they were going through say cancer radiology and other conditions that maybe required injection in office maj treatments

might switch back after treatments are complete, But I had some who didn't want to switch's back to duel plan just stayed PDP after as well

 

[vic120]

Now besides her, I don't know why one doc might take Humana WellCare and another might only take Aetna and uhc

Because there is no consistency in which carriers for all docs

 

[DonP]

Now besides her, I don't know why one doc might take Humana WellCare and another might only take Aetna and uhc

Because there is no consistency in which carriers for all docs

Because carriers like United and Aetna more lenient on approvals than Humana and WellCare . The reason I believe is Aetna and United big med sup carriers thus mapd not all their business . Humana and WellCare 95% of their business Mapd and pdp thus it's almost all their profit center . Drs have a black check to bill medicare without and red tape .reimbursement rates higher with original Medicare . What's also not being said is many people on retirement show less than $35 k net income . Their hospital bills will be forgiven if they apply for a charitable writeoffs . A lot of people making under $50 k are not paying the bills if their moop hit . I've tested this . I had a $500 coinsurance bill 3 years ago . I send in $5 a month . They've never said a word

 

[vic120]

Because carriers like United and Aetna more lenient on approvals than Humana and WellCare . The reason I believe is Aetna and United big med sup carriers thus mapd not all their business . Humana and WellCare 95% of their business Mapd and pdp thus it's almost all their profit center .

I agree in the case of the doc that I worked with

\What I am saying is there also docs who only take plans Like Humana WellCare the plans she didn't like but not the UHC and Aetna and so forth

This I odnt know why

 

[DonP]

I agree in the case of the doc that I worked with

\What I am saying is there also docs who only take plans Like Humana WellCare the plans she didn't like but not the UHC and Aetna and so forth

This I odnt know why

I've noticed by far that most drs in my area take United and Humana. I've rarely seen were 1 takes 1 and not the other . But we're at almost 50% penetration on mapd . Eventually all drs and hospitals will have to accept mapd .No experienced Medicare agent will ever say med sup not far superior coverage than mapd . The question becomes do you want to pay $180 a month for coverage starting at age 65 ( $145 for sup , $23 for part b deductible and $15-$35 for pdp card ) going up 5-8% a yr ?

 

[vic120]

I've noticed by far that most drs in my area take United and Humana. I've rarely seen were 1 takes 1 and not the other . But we're at almost 50% penetration on mapd . Eventually all drs and hospitals will have to accept mapd .

Oh I highly doubt that. Honestly I see less docs and more people. Many docs wont except new people at all anymore


My mil had a horrible time finding a doc that would take new patients when she moved here,