Medicare Advantage Network Law Proposed

Medicare Advantage enrollees in Florida and Connecticut have been faced with losing their doctors or local hospital when their Advantage plan cut its network.   Congresswoman Rosa DeLauro of Connecticut is proposing a Medicare Advantage Participant Bill of Rights Act that would require Medicare Advantage plans to finalize their provider networks 60 days before the annual open-enrollment period begins.

The bill would also prohibit plans from dropping doctors in the middle of the year when people are unable to move to another Advantage plan.

According to DeLauro, this rule would ensure that enrollees know what providers will be covered before they enroll in a plan, or before the Annual Enrollment Period (October 15 – December 7) when they can change plans.

DeLauro jumped into the fray after 30,000 seniors in Connecticut where hit by cuts to the UnitedHealthecare Medicare Advantage plan networks. United dropped about 2,200 providers from its Connecticut network, including Yale New Haven Hospital.

In Florida, about 100,000 Humana Medicare Advantage members faced losing their doctors and hospitals in June when the insurance company announced it would no longer include Baptist Health South Florida hospitals in its provider network.

Network cuts have not happened in Tucson, perhaps because Medicare Advantage plans here have already cut out the most expensive hospital, that being University of Arizona Medical Center (UAMC).

Seven insurance companies offer Medicare Advantage plans in Tucson, but only two of them contract with UAMC. That’s because UAMC gets more money from Medicare for the same operations than the other hospitals in town.  So if a person has doctors with University Physicians, or they want to use UAMC, they have only two Medicare Advantage companies to choose from.

I am originally from Connecticut and know many people who live one hour from New Haven who have been sent to Yale New Haven Hospital for surgery. It seems like many patient from New London (50 miles from New Haven) get sent to Yale New Haven for surgery, even though there are two hospitals in that part of Eastern Connecticut.  Not including Yale New Haven Hospital in any Connecticut Medicare Advantage plan network seems unacceptable.

The dispute is clearly about money and I’d like Congresswoman DeLauro to ask United and Yale New Haven Hospital to explain their dispute.  Is Yale New Haven Hospital asking United to pay more than what United would pay to other hospitals?  Is YNHH asking for higher compensation than they would get from Medicare?

Network disputes are all about money – but it’s not clear who is the greedy party.  Are certain hospitals asking for payments that are too high for the Advantage plans?  Or are the Advantage plans asking hospitals to accept lower payments than they would receive Medicare or other plans would pay?

Congresswoman DeLauro’s bill will not likely pass any time soon.  But if she should hold hearings, it would be interesting hear management from hospitals and Medicare Advantage plans answer questions about their payment disputes.