Health systems have been cutting ties with Medicare Advantage plans left and right, including Raleigh, N.C.-based WakeMed and Zanesville, Ohio-based Genesis HealthCare System.
Systems that previously treated patients covered by Medicare Advantage plans from major payers including UnitedHealthcare, Humana and Anthem no longer find treating those patients cost effective or sustainable.
Physicians from two practices, including the Craniospinal Center of Los Angeles and Bedminster, N.J.-based IGEA Neuro, told Becker's they are also no longer accepting MA-covered individuals, citing hefty administrative requirements, continued reimbursement decreases and coverage denials.
Question: Do you/does your practice currently accept Medicare Advantage patients? Why or why not?
Brian Gantwerker, MD. Neurosurgeon at the Craniospinal Center of Los Angeles: We currently are no longer accepting Medicare Advantage. The restrictions regarding these plans have made taking care of patients extremely cumbersome. Even routine studies are denied. I had a patient I met when on call with an odontoid fracture. I fixed the fracture by fusing the first and second vertebrae together from the back. Her plan denied a follow-up CT scan, which is routine, at six months. The plan denied the scan because she "did not have a spinal cord injury." We appealed because: 1) The whole reason I did the surgery was so she wouldn't get a spinal cord injury; and 2) The proper study for a spinal cord injury would very likely be an MRI, except in certain situations. Either way, the denial was ridiculous. If you couple that with payment issues — late or no payment all, along with increasingly uncovering the money-making scam MA plans have turned out to be — taking these plans becomes a losing option. I feel for the members and encourage them to talk to their insurance agents, or in some cases, their human resources people to seek other options. Many hospitals have also stopped taking them altogether. The unfortunate truth is that the companies offering these plans and TV commercials mislead patients into thinking they are doing the right thing. The patients lose by giving these for-profit companies their hard-won Medicare benefits while the companies don't pay anyone who is giving care. It's a scam whose end time has come.
Ciro Randazzo, MD. Neurosurgeon at IGEA Neuro: No, we do not. We have stopped seeing these patients due to poor and decreasing reimbursement as well as increased paperwork and administrative requirements for the plans.