DeLauro Proposing Bill Offering Patient Protections In Medicare Advantage Rules

April 12--HAMDEN -- U.S. Rep. Rosa DeLauro announced Friday she will introduce legislation to tighten restrictions on insurers that sell Medicare Advantage plans, giving patients more advance notice when insurers change their physician networks.

The legislation would:

-- Prohibit companies that sell Medicare Advantage plans from dropping clinicians in the middle of the year, ensuring that patients don't lose access to their doctors and other health care providers between enrollment periods each fall.

-- Require Medicare Advantage plans to finalize their networks 60 days in advance of the annual enrollment period for Medicare Advantage.

The current rules require companies that sell Medicare Advantage plans to provide 30 days' notice to beneficiaries when there is a change to the physician network. Insurers are allowed to change their networks at any time.

DeLauro, a New Haven Democrat, announced the proposed legislation while hosting an event Friday afternoon at the Hamden Government Center to talk to constituents about her new "Medicare Advantage Participants Bill of Rights." More than a dozen patients, and several doctors, attended the meeting.

The Connecticut State Medical Society embraced DeLauro's bill, saying she was addressing issues of fairness, transparency and access to care.

Her proposed bill comes just days after the federal Centers for Medicare and Medicaid Services, or CMS, established a new set of procedural rules, increasing oversight of insurance companies and other health plans that sell Medicare Advantage plans to customers.

Medicare Advantage is an alternative to traditional, fee-for-service Medicare provided from the federal government directly to patients. Medicare Advantage is managed by insurers and other health plans.

In a set of new CMS rules announced Monday, insurers that sell Medicare Advantage plans must notify CMS no less than 90 days before the effective date of a planned change to its physician network. The plans are encouraged to provide additional advance notice to beneficiaries and clinicians in the network who are affected by the change.

Additionally, CMS is establishing a policy to grant Medicare Advantage customers a special enrollment period when they are affected by significant changes to their physician network mid year. CMS will determine when a network changes warrants a special enrollment period.

Last fall, UnitedHealthcare sent letters to customers and doctors indicating major changes to its Medicare Advantage physician network starting Feb. 1. The insurer has not said how many doctors it planned to cut, but the Fairfield County Medical Association said it was 810 primary care physicians and 1,440 specialists across Connecticut. UnitedHealthcare also cut its network in other states.

Separately, UnitedHealthcare and Yale-New Haven Health System failed to reach an agreement regarding the insurer's Medicare Advantage network. As a result, Yale-New Haven Hospital, including its Saint Raphael campus, have been out of UnitedHealthcare's Medicare Advantage network since April 1.

Addie Raucci, 71, of Branford, and her husband, Lou, have had UnitedHealthcare's Medicare Advantage plans for years. They had HealthNet before that company stopped selling policies in Connecticut several years ago. Lou has had Parkinson's disease for 10 years, and they both are treated by doctors who are now out of UnitedHealthcare's network, Addie Raucci said. She called the insurer's actions are "insulting and egregious."

UnitedHealthcare spokeswoman Jessica Pappas said in a statement: "We understand that any plan changes can be unsettling, and are working with local members and doctors to address questions and concerns they may have. This includes helping to ensure that a member's current course of treatment is not interrupted."

New Haven cardiologist Steven Wolfson was one of several doctors who attended DeLauro's meeting Friday. He was dropped from UnitedHealthcare's network.

"There was no real effort to help patients find new physicians, or to find out if there were physicians who could pick up a few thousand new patients," Wolfson said.

"God bless Rosa," he said. "She has been involved from the start, listening to all of us, and spending countless hours calling both United and CMS to redress this wrong."

Pappas, the UnitedHealthcare spokeswoman, said, "Our Medicare Advantage members continue to have broad access to hospitals and physicians across Connecticut to meet their health care needs, and we will work with them to ensure access to those providers.

"Medicare Advantage plan members who have questions may call the number on the back of their ID cards," Pappas said.

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