"We've every facility here for dealing with people who are rich. We can deal with a blocked purse, we can drain private accounts and in the worst eases we can perform a total cashectomy, which is total removal of all moneys from the patient."
Posted on 11/24/2023 10:47:42 AM PST by buckalfa
Medicare Advantage provides health coverage to more than half of the nation's seniors, but a growing number of hospitals and health systems nationwide are pushing back and dropping some or all contracts with the private plans altogether.
Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. Some systems have noted that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over their high denial rates.
"It's become a game of delay, deny and not pay,'' Chris Van Gorder, president and CEO of San Diego-based Scripps Health, told Becker's. "Providers are going to have to get out of full-risk capitation because it just doesn't work — we're the bottom of the food chain, and the food chain is not being fed."
In late September, Scripps began notifying patients that it is terminating Medicare Advantage contracts for its integrated medical groups, a move that will affect more than 30,000 seniors in the region. The medical groups, Scripps Clinic and Scripps Coastal, employ more than 1,000 physicians, including advanced practitioners.
Mr. Van Gorder said the health system is facing a loss of $75 million this year on the MA contracts, which will end Dec. 31 for patients covered by UnitedHealthcare, Anthem Blue Cross, Blue Shield of California, Centene's Health Net and a few more smaller carriers. The system will remain in network for about 13,000 MA enrollees who receive care through Scripps' individual physician associations.
"If other organizations are experiencing what we are, it's going to be a short period of time before they start floundering or they get out of Medicare Advantage," he said. "I think we will see this trend continue and accelerate unless something changes."
Bend, Ore.-based St. Charles Health System took it a step further and was not only considering dropping all Medicare Advantage plans, but also encouraged its older patients not to enroll in the private plans during the upcoming enrollment period in October. The health system's president and CEO, CFO and chief clinical officer cited high rates of denials, longer hospital stays and overall administrative burden for clinicians. Ultimately, the health system has decided to remain in network with four MA carriers and will not renew contracts with three.
"We recognize changing insurance options may create a temporary burden for Central Oregonians who are currently on a Medicare Advantage plan, but we ultimately believe it is the right move for patients and for our health system to be sustainable into the future to encourage patients to move away from Medicare Advantage plans as they currently exist," St. Charles Health CFO Matt Swafford said.
"I feel terrible for the patients in this situation; it's the last thing we wanted to do, but it's just not sustainable with these kinds of losses," Mr. Van Gorder added. "Patients need to be aware of how this system works. Traditional Medicare is not an issue. With these other models, seniors need to be wary and savvy buyers."
Here are 13 more recent instances of hospitals dropping Medicare Advantage contracts:
In October, the Nebraska Hospital Association issued a report detailing how Medicare Advantage is "failing patients and jeopardizing Nebraska hospitals," 33% of which do not accept MA patients. The report cited negative patient experiences, post-acute placement delays, and administrative and financial burdens on hospitals that accept MA patients.
York, Pa.-based WellSpan Health will no longer accept Humana Medicare Advantage and UnitedHealthcare-AARP Medicare Advantage plans starting Jan. 1. UnitedHealthcare group MA PPO and Humana employer PPO MA plans will still be accepted.
Greenville, N.C.-based ECU Health said it anticipates it will no longer be in network with Humana's Medicare Advantage plans starting Jan. 1.
Raleigh, N.C.-based WakeMed went out of network with Humana Medicare Advantage plans in October. According to CBS affiliate WNCN, the plan provides coverage to about 175,000 retired state employees. WakeMed cited a claims denial rate that is "3 to 4 times higher" with Humana compared to its other contracted MA plans.
Zanesville, Ohio-based Genesis Healthcare System is dropping Anthem BCBS and Humana Medicare Advantage plans in 2024.
Brunswick-based Southeast Georgia Health System will terminate its contract with Centene's WellCare Medicare Advantage plan on Dec. 8. The system said it started negotiations with the carrier after years of "inappropriate payment claims and unreasonable denials."
Nashville, Tenn.-based Vanderbilt Health went out of network with Humana's HMO Medicare Advantage plan in April.
Fayetteville, N.C.-based Cape Fear Valley Health dropped UnitedHealthcare Medicare Advantage plans in July.
Corvallis, Ore.-based Samaritan Health Services ended its commercial and Medicare Advantage contracts with UnitedHealthcare. The five-hospital, nonprofit health system cited slow "processing of requests and claims" that have made it difficult to provide appropriate care to UnitedHealth's members, which will be out of network with Samaritan's hospitals on Jan. 9. Samaritan's physicians and provider services will be out of network on Nov. 1, 2024.
Cameron (Mo.) Regional Medical Center stopped accepting Cigna's MA plans in 2023 and plans to drop Aetna and Humana in 2024. It plans to continue Medicare Advantage contracts with UnitedHealthcare and BCBS, the St. Joseph News-Press reported. Cameron Regional CEO Joe Abrutz previously told the newspaper the decision stemmed from delayed reimbursements.
Stillwater (Okla.) Medical Center has ended all in-network contracts with Medicare Advantage plans amid financial challenges at the 117-bed hospital. The hospital said it made the decision after facing rising operating costs and a 22% prior authorization denial rate for Medicare Advantage plans, compared to a 1% denial rate for traditional Medicare.
Brookings (S.D.) Health System will no longer be in network with nearly all Medicare Advantage plans in 2024, with the exception of Medica. The 49-bed, municipally owned hospital said the decision was made to protect the financial sustainability of the organization.
Louisville, Ky.-based Baptist Health Medical Group went out of network with Humana's Medicare Advantage plans in September, Fox affiliate WDRB reported. The system will also go out of network with UnitedHealthcare and Centene's WellCare on Jan. 1 without a new agreement in place
in 2002 I had a 5 way bypass in Anaheim Cardio Hospital. They kept me 4 days before surgery, because they wanted the blood thinner out of my system So I was there in cardio ICU 7 days, including 3 days after a 7 hour surgery.
Cost? 225,000 I paid nothing, including for physical rehab.
Yup—the investment space is particularly brutal.
In these days of super low fees do it yourself investing these legacy high fee firms prey on seniors who have not figured out the new world of investing.
“Physicians are good for setting bones and stitching cuts..but that’s about all today.”
Anyone with a computer these days who does not immediately Google “nutrition and supplements to help condition XXX” after a diagnosis is missing important help. Three years ago doctors said my cataracts must have surgery as no treatment existed. I discovered at Google there were indeed several supplements I was not yet taking that could help. After 3 years my vision is 70 to 80% better. The glare of headlights no longer bothers my night driving except for those high brightness bluish headlights that everyone hates.
Even if you just think you have a health problem do the Google search. Then when you go to get a confirmed diagnosis you will have some pointed questions to ask. Unfortunately, you will discover that most doctors know almost nothing about nutrition, not even what can help or hurt in their specialty should you happen to be directed to a specialist by your GP or Internal Medicine practitioner.
As we have discovered, almost all the $6 billion a year that Dr. Fauci controlled was directed to drug research, very little to prevention or nutritional related treatments. As of late spring 2020 he said Vitamins C and D were not helpful for Covid. By Nov. that year he had to reluctantly admit he might be wrong based on a lot more information about Covid infections.
Not just the ILLEGALS, thinden.....the elephant in the room, that hasn’t been mentioned by the leftist, lying media and CDC is.... it’s likely the D@MN $hots causing the ‘catastrophic harm’ on our healthcare system.
All. By. Design.
^^^^^^^^^^
excellent observation, jane.
Sure looks like it.
225,000 I paid nothing, including for physical rehab.
—
Sounds like a teachers union, federal or state plan.
It’s all part of going toward Universal Healthcare.....time is not on our side for too much longer.
good on you
not that supplementals are the greatest, my BCBS is going up 60% 1/1/2024, $406.00
and i have to pay it, i need it...
Watch your perscription plans.....mine was dropped and will swich to new plan Jan. 1st. We have no say in this for the most part.
Oh, it’s a lot worse than that. They use multiple names for the same things and in some cases one name can refer to two different plans.
I lucked out and had an advisor who also shows the insa nd ours of Medicare approaches.
Do you know the actual amount that was paid? And how are you covered, meaning insurance and/or Medicare?
You may find this podcast interesting:
How To Prevent and Reverse Cataracts
by Dr. Bryan Ardis | Oct 3, 2023 | Health
https://www.americaoutloud.news/how-to-prevent-and-reverse-cataracts/
The ‘billed rate’ and the paid rate by medicare AND insurers with agreements are vastly different. From what I’ve seen in my own bills from hospitals the actual payoff is less than 10% of the billed amount.
That’s what the supplemental insurance is there for. With Medicare and my grandfathered Plan F plan, I actually haven’t had to pay anything.
Yes, that dime on the dollar is my experience, too. But someone has to be paying a LOT higher, or the hospitals would all go bankrupt yesterday. I have tried and tried to get the facts, but no cigar.
bttt
The ‘billed rate’ and the paid rate by medicare AND insurers with agreements are vastly different. From what I’ve seen in my own bills from hospitals the actual payoff is less than 10% of the billed amount.
Yes, that dime on the dollar is my experience, too. But someone has to be paying a LOT higher, or the hospitals would all go bankrupt yesterday. I have tried and tried to get the facts, but no cigar.
xxxxxxxxxxxxxxxxx
you think that the Rx prescription side is the bigger racket?
Hospitals jump for joy when they present a bill to a monied-patient with no real insurance because they’re stupid enough to actually pay that inflated bill. One example is birthing - a young couple having their first child and really no insurance to speak of.
My advice to ANYONE who doesn’t have insurance or their insurance won’t cover something is to do a little work and interaction with the hospital financial arm and work out a cash price paid up front deal.
"We've every facility here for dealing with people who are rich. We can deal with a blocked purse, we can drain private accounts and in the worst eases we can perform a total cashectomy, which is total removal of all moneys from the patient."
About half do not have any private insurance. The births are paid for by way of Medicaid. I can't get an answer, but I doubt Medicaid is more than the dime on the dollar allowed by Medicare...... https://wisconsinwatch.org/2023/05/does-medicaid-cover-nearly-half-of-all-births-in-the-us/#:~:text=In%20Wisconsin%2C%2035%25%20of%20all,about%20everything%20happening%20in%20Wisconsin.
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