Tuesday, December 3, 2013

YEP, the ACA is working. That's why thousands of Medicare patients are losing access to specialists

It would be funny if (a) it didn't involve real people who already depended on government promises of coverage, and (b) it were not so predictable.

As the $156 billion in cuts for seniors on Medicare advantage kick in, thousands of doctors are being dropped by insurance companies, and patients with serious, even terminal conditions are being forced to scramble for new care or new insurance:

Dorathy Senay’s doctor had some bad news after her last checkup, but it wasn’t about her serious blood disorder called amyloidosis. Her Medicare Advantage managed care plan from UnitedHealthcare/AARP is terminating the doctor’s contract Feb. 1. 
She is also losing her oncologist at the prestigious Yale Medical Group – the entire 1,200-physician practice was axed. 
Senay, 71, of Canterbury, Conn., is among thousands of UnitedHealthcare Medicare members in 10 states whose doctors will be cut from their plan network.
Neither the Feds nor the insurance companies are being forthcoming with the data about how many seniors are being hurt here, but USA Today makes an effort to get the data:
While Medicare officials would not disclose how many provider terminations they are scrutinizing, state medical groups have provided some tips. The Ohio State Medical Association estimates UnitedHealthcare has canceled contracts with hundreds of Ohio doctors effective Jan. 1. The cancellations include most of the orthopedic surgeons in Dayton, the only hand specialty practice serving the Cincinnati area, a large gastroenterology practice with 2,500 patients that also provides most of the inpatient care at five Cincinnati-area hospitals, and the largest practice of retina specialists serving 600 UnitedHealthcare members, many with macular degeneration, in central and southern Ohio. 
In Connecticut, UnitedHealthcare is terminating about 2,250 physicians, including 810 specialists, Feb. 1, said Mark Thompson, executive director of the Fairfield County Medical Association, prompting the medical associations in Fairfield and Hartford counties to file a federal lawsuit to stop the cancellations. 
In New York City, UnitedHealthcare’s contracts with about 2,100 physicians will be canceled, affecting some 8,000 patients, according to the Medical Society of New York. In Florida, UnitedHealthcare dropped the state’s only National Cancer Institute-designated cancer treatment facility, the Moffitt Cancer Center, and its 250 physicians in Tampa. 
Of course, we are receiving messages of sympathy and support from the Feds and the insurance companies:

UnitedHealthcare spokeswoman Jessica Pappas said in a written response to questions, “While these changes can be difficult for patients and their doctors, they are necessary to meet rising quality standards, slow the increase in health costs and sustain our plans in an era of Medicare Advantage funding cuts.” However, the doctors dropped from Medicare Advantage plans can still treat patients covered under other UnitedHealthcare policies. 
The Affordable Care Act phases in reductions in government payments to Medicare Advantage plans – $156 billion over 10 years – to bring the program into line with the costs of caring for seniors in traditional Medicare.
I guess the promise that if you like your insurance you can keep it apparently (a) made no guarantees about access to the physicians you used to have; and (b) didn't apply to Medicare Advantage patients.

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