Medicare Advantage change? New referrals needed.

During the Medicare Open Enrollment Period that just ended on December 7th, many people changed from one Medicare Advantage (MA) plan to another.  Some changed because their doctors were no longer accepting their old MA plan. Some changed because the new plan offers lower co-pays for specialist office visits or hospital stays.

The reasons for changing an MA plan may be varied, but the results are the same for everybody: They need to get new referrals from their Primary Care Physician (PCP) to see their specialists.

Most of the Medicare Advantage plans in Arizona are HMOs (Health Maintenance Organizations), and HMO’s require referrals in order to see a specialist.  So when a person changes to a new MA plan, they are going to have to go back to their PCP office to get referrals set up for 2013.  If they have an appointment to see their cardiologist in January, and they show up  without a referral through their new plan, that could be a problem.

Some Medicare Advantage plans will allow multi-visit referrals, so seeing the dermatologist two or three times per year only requires one referral. But some MA plans are allowing only one-visit referrals, and this means going back to the PCP office for the paperwork every time you need to see your specialist.

I’m not sure how limiting referrals to one visit to the specialist helps control costs for the Medicare Advantage plan – it just seems to create more work for the Primary Care Physician’s (PCP) office. And when a patient arrives at the dermatologist’s office without a referral, the staff will either turn that patient away, or they will get on the phone and ask the PCP office to send over the paperwork ASAP. So instead of lowering costs, it looks to me like it means doctors need more office staff to handle more paperwork. What a system!

But you can’t fight the system, so be advised that if you’ve changed your Medicare Advantage plan, you’ll need to set up new referrals to all your specialists for 2013.

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