Doctors' frustrations with Medicare Advantage may arise from too much administrative work, claim denials, and network restrictions. Not all doctors accept Medicare, often because reimbursement rates are low and program requirements can be demanding, which can leave patients facing higher out-of-pocket costs. Prior approval is a big point of friction for those seeking Home Care near Newtown PA. Virtually all Medicare Advantage enrollees are in plans that require the insurer to sign off in advance for at least some care, according to KFF. Doctors' frustrations with Medicare Advantage may arise from too much administrative work, claim denials, and network restrictions. Not all doctors accept Medicare, often because reimbursement rates are low and program requirements can be demanding, which can leave patients facing higher out-of-pocket costs. Prior approval is a big point of friction for those seeking Home Care near Newtown PA. Virtually all Medicare Advantage enrollees are in plans that require the insurer to sign off in advance for at least some care, according to KFF.
Insurers say that process ensures treatments are coordinated and appropriate. While it is rare for a doctor to stop accepting a Medicare Advantage plan, it could happen. The most common reason that doctors may discontinue their acceptance of Medicare Advantage is that the private insurance company makes it difficult or time-consuming for the doctor to get paid for their services. There are several reasons why some doctors choose not to accept Medicare patients.
One of the most common reasons is that they do not feel that the reimbursements provided by Medicare cover the costs associated with providing care for these patients. Additionally, some doctors may have concerns about the paperwork or bureaucracy that comes along with treating Medicare patients. Other doctors may simply be overwhelmed with the number of patients they already have and don’t want to take on additional Medicare beneficiaries. These authorization requirements can lead to frustration and burnout for doctors and their staff and potential treatment delays for patients.
If you receive care and they have opted-out of Medicare, you could be responsible for the full cost of the treatment out-of-pocket. Parts of the CARES Act were extended, including increased flexibility for Medicare to cover telehealth services. Your current doctor has probably already prepared for this eventuality and arranged to transfer Medicare patients to another physician's care. If your doctor is what's called a non-participating provider, it means they haven't signed an agreement to accept assignment for all Medicare-covered services, but can still choose to accept assignment for individual patients.
Lipschutz thinks providers are feeling emboldened following a study by the Health and Human Services Department’s inspector general published last year that found some Advantage plans have denied coverage for care that should have been provided under Medicare’s rules. These restrictions may create issues when doctors are making specialist referrals or sending patients to other facilities for care. It simply means that the patient will need to pay out-of-pocket for any services they receive from this doctor and then submit a claim to Medicare for reimbursement. But the focus now on Medicare Advantage “seems different, said David Lipschutz, associate director and senior policy attorney for the Center for Medicare Advocacy, who says hospitals and doctors are becoming “much more vocal about their frustrations with some of the insurers’ cost-control efforts.
Your doctor may be able to offer alternative solutions that would make it possible for you to receive care from them while still receiving reimbursement from Medicare. Instead, you can ask your doctor for a referral to another healthcare provider that does accept Medicare, do your own research, or visit an urgent care facility.
