Medicine Protests Medicare Advantage Terminations

Physicians across the country are being kicked out of Medicare Advantage (MA) plans, undermining patients' rights and denying them access to care, TMA, the American Medical Association, and numerous national specialty societies and state medical associations say in a letter to the Centers for Medicare & Medicaid Services (CMS). 

They asked CMS "to take immediate action" to make sure Medicare beneficiaries participating in MA plans "have accurate and reliable information to make health insurance elections during the 2014 Open Enrollment period …"

The letter says hundreds of physicians hare reported they were terminated from MA networks. "The terminations are 'without cause' and have been timed in a manner that undermines the accuracy and reliability of the information Medicare beneficiaries are relying upon in order to make important health care decisions for 2014 health insurance coverage. The timing and process used to communicate the terminations and modifications to the networks are not consistent with CMS guidance and regulations," the letter says. 

They added that the terminations "will disrupt long-established patient-physician relationships, interfere with existing physician referral networks, and undermine emergency department coverage in many hospitals. Both the continuity and coordination of care will be negatively affected, and treatment for certain types of care commonly provided by a very limited number of sub-specialists may no longer be available within the network."

TMA and the others urged CMS to extend the MA open enrollment period and require MA plan sponsors that have reduced their networks to immediately:  

  • Provide and document that patients received actual and accurate notice of whether their current physicians will be in the 2014 network;  
  • Ensure that patients know they can retain their physician by choosing fee-for-service or by choosing a product with an out-of-network benefit if their plan provides one; 
  • Give physicians information needed to challenge network adequacy based on CMS regulations and extend the appeals deadline until physicians receive such information;  
  • Tell AMA and the state medical societies how many patients are impacted and which physicians were terminated; and
  • Direct plans to hold all terminations initiated just prior to or during Open Enrollment in abeyance for 2014.    

Action, Nov. 15, 2013

 


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