4 Complaints Providers Have with Medicare Advantage

Medicare Advantage plans are widely popular among Medicare-eligible consumers, but not everyone is fond of them.

September 12, 2014 | By Dina OverlandMedicare Advantage

Medicare Advantage plans are widely popular among Medicare-eligible consumers, but not everyone is fond of them. Many providers actually dislike the Medicare Advantage program and, therefore, are reluctant to contract with Medicare Advantage Insurers reported NerdWallet.

There are five common issues that providers have with the Medicare Advantage insurers, which continue to boost their enrollment numbers with broader coverage than traditional Medicare, FierceHealthPayer previously reported. Three of them are summarized below.

  1. Complicated authorization and reimbursement. Many providers complain that the Medicare Advantage authorization process is tedious and delayed, which drains resources and their staff’s time. Providers also frequently have to dispute claims far more often than for Medicare. “Even if the payment is eventually the same, the cost of the added paperwork, stress, processes, appeals, calls and staff time bites through any profit, quickly causing a practice to lose money,” Martine Brousse, a patient advocate and health industry expert, said in the NerdWalletarticle.
  2. Unclear policies. Unlike traditional Medicare, which has clear guidelines explaining which treatments are covered and at what price, Medicare Advantage requirements differ for each insurer. That means providers potentially must reach out to individual Medicare Advantage insurers each time a patient needs treatment. What’s more, Medicare Advantage insurers can require providers to take certain steps, including offering cheaper, non-surgical or less drastic treatments, so providers must call the companies to determine what treatment they can deliver to their patients.
  3. Unpaid patient balances. Providers worry that they risk losing payments from some patients with a Medicare Advantage plan because those patients have a high liability. Traditional Medicare patients often have secondary insurance to help them cover expensive healthcare bills, making it easier for providers to collect payment. But since few Medicare Advantage members have secondary insurance and many of their policies have higher deductibles and out-of-pocket costs, it’s often more challenging for them to pay their bills.