Medicare Advantage Patients Complain To CMS About Lean Provider Networks
CMS sought comments on ways that it can improve Medicare Advantage. The majority of feedback came from providers, but beneficiaries also weighed in with horror stories about deficient networks.
Stat:
Physicians Take Medicare Advantage To Task For Rural Patients’ Care Gaps
In January, the Biden administration asked, once again, for ideas on how to improve Medicare Advantage. And it got, once again, a flood of people sharing horror stories about the embattled program when the comment period closed last week. Most of the comments came from doctors, home health and hospice providers, medical device suppliers, and hospitals. Many of the commenters, like the doctors in California, urged CMS to ensure MA plans contract with enough providers so that members don’t have to travel far for care. Others shared the usual concerns: insurers using the prior authorization process to avoid paying bills and underpaying providers. New Biden administration rules around prior authorization and other aspects of MA took effect this year, including the requirement that a prior authorization approval remain valid throughout the full course of an enrollee’s treatment. (Bannow, 6/3)
Modern Healthcare:
Medicare Pay Bundling Program May Overwhelm Providers: AHA, FAH
Hospital groups say a proposed mandatory Medicare payment bundling program may prove overly burdensome to an industry already working to implement other Centers for Medicare and Medicaid Services reimbursement experiments. Last month, the Center for Medicare and Medicaid Innovation requested comments on its Transforming Episode Accountability Model, or TEAM, which would employ episode-based reimbursement for ... procedures at select hospitals for five years starting in 2026. (Early, 5/31)
The Guardian:
Delays, Denials, Debt And The Growing Privatization Of Medicare
Private insurers now cover roughly half of the nation’s 68 million Medicare beneficiaries. Their dominance of this space has grown rapidly over the past two decades – at the expense of patient care, according to healthcare activists and patients, as corporations often deny medical care directed by doctors. (Sainato, 6/3)
Milwaukee Journal Sentinel:
Ascension Agrees To Investigate 4 Patients' Medical Billing Complaints
The Nelsons' story is among dozens of emails and calls Public Investigator received from Ascension patients after publishing a story about a Milwaukee couple who spent months fighting a medical bill for a checkup. Most involved Medicare users or older adults, and all cited difficulties communicating with Ascension customer service regarding billing errors. (Clark and Fowlkes, 6/3)
In Medicaid updates —
Reuters:
Centene CEO Says Its Membership Shifted To Sicker Patients Due To Medicaid Turnover
Health insurer Centene's chief executive said on Friday that turnover in people enrolled in Medicaid plans had led to a shift to sicker patients in its membership, but stood by its 2024 earnings and cost forecasts. Centene CEO Sarah London said that around 30% of Medicaid recipients who lost their membership when re-enrollment started last year had been taken off the list inappropriately. (Niasse, 5/31)
Fierce Healthcare:
UnitedHealth Projects Shaky Medicaid Redetermination Aftermath
UnitedHealth is predicting an upcoming “disturbance” among its Medicaid programs as members continue to disenroll after the COVID-19 public health emergency. The company's stock price dropped following CEO Andrew Witty’s remarks at a recent investor conference, with the price still down at the time of publication. Other insurers, like Centene, Molina Healthcare and Elevance Health, have seen their stocks take a dive as well, though Humana’s has since recovered. (Tong, 5/31)
NPR:
A Cancer Patient’s Struggle With Georgia Medicaid
Four years ago, Amy Wilson's life and dreams were put in jeopardy when doctors found a cancerous tumor in her brain. She had two choices: forgo chemo and surgery and possibly lose her life or get treatment and figure out how to pay for it later. She ended up having surgery a few weeks before the coronavirus pandemic shut down Georgia and most of the world. Wilson was already on Medicare because of an existing disability, and it covered some of her surgery expenses, but Wilson still struggles to pay for her ongoing care.“My life was good before brain cancer and I miss it,” Wilson said. (Manuel, Martinez, Guevara and Bearne, 6/3)
