[golfing eagles]

Originally Posted by CoachKandSportsguy

https://x.com/CarolynMcC/status/1851217718759862390

30 health systems dropping Medicare Advantage plans | 2024
must register to read but is free to register, or hit the already a member link, and then close the login box, and read the article. . (my hack)

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Medicare Advantage provides health coverage to more than half of the nation's older adults, but some hospitals and health systems are opting to end their contracts with MA plans over administrative challenges.

Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers.

In 2023, Becker's began reporting on hospitals and health systems nationwide that dropped some or all of their Medicare Advantage contracts.

Data on this topic is limited. In January, the Healthcare Financial Management Association released a survey of 135 health system CFOs, which found that 16% of systems are planning to stop accepting one or more MA plans in the next two years. Another 45% said they are considering the same but have not made a final decision. The report also found that 62% of CFOs believe collecting from MA is "significantly more difficult" than it was two years ago.

30 health systems dropping Medicare Advantage plans in 2024:
Editor's note: This is not an exhaustive list. It will continue to be updated this year

Robbinsdale, Minn.-based North Memorial Health is ending its contract with Humana Medicare Advantage, effective Dec. 31, 2024.

Watertown, S.D.-based Prairie Lakes Healthcare System will drop Humana Medicare Advantage in 2025.

North Kansas City (Mo.) Hospital and Meritas Health will no longer be in-network with Aetna Medicare Advantage plans, effective Oct. 1, 2024.

Nashville-based Vanderbilt Health will no longer be in network with BCBS Tennessee Medicare Advantage, effective in 2025.

Sioux Falls, S.D.-based Avera Health will end participation as an in-network provider with Humana Medicare Advantage on Dec. 31, 2024.

Duluth, Minn.-based Essentia Health will no longer accept UnitedHealthcare and Humana Medicare Advantage in 2025.

Quincy, Ill.-based Blessing Health is implementing a new MA approach in 2025 and will only contract with BCBS, UnitedHealthcare, Molina and Total Retiree Advantage Illinois.

Lawrence, Kan.-based LMH Health will no longer accept Aetna or Humana Medicare Advantage, effective Jan. 1.

Brewer, Maine-based Northern Light Health is ending its Medicare Advantage contract with Humana, effective Sept. 30.

Sioux Falls, S.D.-based Sanford Health is dropping Humana Medicare Advantage in Minnesota in 2025.

North Platte, Neb.-based Great Plains Health will no longer accept any Medicare Advantage plans in 2025.

Kimball (Neb.) Health Services will no longer accept any Medicare Advantage plans starting in 2025.

Carson City, Nev.-based Carson Tahoe Health will no longer be in network with UnitedHealthcare Medicare Advantage by May 30, 2025.

Midland-based MyMichigan Health will no longer participate in the Aetna Medicare Advantage Network at all facilities after Dec. 31.

Bloomington, Minn.-based HealthPartners will no longer be in network with UnitedHealthcare Medicare Advantage plans by 2025.

Canton, Ohio-based Aultman Health System's hospitals will no longer be in network with Humana Medicare Advantage after July 1, and its physicians will no longer be in network after Aug. 1.

Albany (N.Y.) Med Health System stopped accepting Humana Medicare Advantage on July 1.

Munster, Ind.-based Powers Health (formerly Community Healthcare System) went out of network with Humana and Aetna's Medicare Advantage plans on June 1.

Lawton, Okla.-based Comanche County Memorial Hospital stopped accepting UnitedHealthcare Medicare Advantage plans on May 1.

Houston-based Memorial Hermann Health System stopped contracting with Humana Medicare Advantage on Jan. 1.

York, Pa.-based WellSpan Health stopped accepting Humana Medicare Advantage and UnitedHealthcare Medicare Advantage plans on Jan. 1. UnitedHealthcare D-SNP plans in some locations are still accepted.

Newark, Del.-based ChristianaCare is out of network with Humana's Medicare Advantage plans as of Jan. 1, with the exception of home health services.

Greenville, N.C.-based ECU Health stopped accepting Humana's Medicare Advantage plans in January.

Zanesville, Ohio-based Genesis Healthcare System dropped Anthem BCBS and Humana Medicare Advantage plans in January.

Corvallis, Ore.-based Samaritan Health Services' hospitals went out of network with UnitedHealthcare's Medicare Advantage plans on Jan. 9. Samaritan's physicians and provider services will be out of network on Nov. 1.

Cameron (Mo.) Regional Medical Center stopped accepting Aetna and Humana Medicare Advantage in 2024.

Bend, Ore.-based St. Charles Health System stopped accepting Humana Medicare Advantage on Jan. 1 and Centene MA on Feb. 1.

Brookings (S.D.) Health System stopped accepting all Medicare Advantage plans in 2024.

Louisville, Ky.-based Baptist Health went out of network with UnitedHealthcare Medicare Advantage and Centene's WellCare on Jan. 1.

San Diego-based Scripps Health ended all Medicare Advantage contracts for its integrated medical groups, effective Jan. 1.

Originally Posted by bob47

You are correct. Typically around 1/3 of the billed amount is actually paid and accepted as payment in full. So, what is the actual fair value of the procedure? And what happens to the 2/3 that is not paid? And why should a person with no insurance pay more than the amount that Medicare pays?

OK, so 30 hospitals across the US are "dropping" advantage plans, subject to change depending on some last-minute negotiations. But to put it in perspective, there are 6,120 hospitals and over a million physicians in the US, so no biggie.

As far as billing goes, a provider is stupid if they don't set their fees at least 10% above the highest paying 3rd party insurer---it's just leaving money on the table, and since they generally accept insurance as full payment, it doesn't matter---UNLESS the patient has no insurance. Then it becomes ridiculously unfair especially if the provider is billing triple what they know they will get from insurance. Here's an example from 10-15 years ago. Medicare would reimburse a chem 12 profile about $13 at the time. Our best private insurance would pay $18. So we set the fee at $20. The hospital lab across the parking lot unbundled the CPT codes and charged $295 for the same thing---of course they got the same $13 and $18 as we did and accepted it (It costs about $7.75 to run the test). BUT.... while a patient with no insurance owed us $20, which we frequently just wrote off, they owed the hospital $295 if they went there, and the hospital would aggressively send them to collections. Completely ridiculous in my opinion. Just part of the reason our healthcare system needs some substantial changes.