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Medicare Advantage Plan Terminations

Alert — Nov. 5, 2013

Impacted States

UnitedHealthcare, BCBS Affiliates, Humana Medicare Advantage and possibly others are cutting their Medicare Advantage provider networks. Academy members recently began receiving termination letters stating that their Medicare Advantage contracts will end in early 2014. At least fourteen states are affected at this point: California, Connecticut, Florida Indiana, Montana, Nevada, New Jersey, New York, Ohio, Rhode Island, Tennessee, Texas, Utah and Wyoming. Both subspecialists and general ophthalmologists are impacted.

What is Medicare Advantage?

Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide all Part A and Part B benefits. For patients who are enrolled in a Medicare Advantage plan, their Medicare services are provided through the plan and aren’t paid for under original Medicare.

Academy response

The Academy and the American Medical Association have asked the Centers for Medicare and Medicaid Services (CMS) to look into the large-scale terminations. CMS is required to evaluate major changes to insurance networks. Read the Academy response.

What to do if terminated?

1.  File an appeal with the insurer.
Follow the appeals process spelled out in the insurer’s notice. Specify the anticipated impact upon the practice and the patient care including disruption to future scheduled appointments (e.g., surgeries scheduled and post-op follow-up); unique services provided by the practice; the number of lives being cared for; access issues to other area physicians; and your subspecialty and how important that particular care is to your patients.

2.  Engage patients.
Use this patient letter template [WORD 23K] to inform your affected network patients that you will no longer be able to provide care to them if they remain with the insurer. The template reminds patients that they have until December 7 – the close of Medicare’s open-enrollment period – to choose a different Medicare Advantage plan or enroll in traditional Medicare.

3.  File a Complaint with your State Department of Insurance. 

4.  Contact your State Society

5.  Contact Kelsey Lang at the Academy’s Washington Office.
If terminated, email Kelsey Lang, the Academy’s manager of quality and payment policy. The Academy is collecting information on the scope of this issue including the number of physicians affected so far and their ophthalmic specialties.