Corvallis Clinic letter about Medicare upsets, confuses patients

Last month, many Corvallis Clinic patients received a letter in the mail that left them upset and confused about their insurance coverage.

Now, patients on original Medicare are wondering about what steps to take next to get the care they need, they said in interviews, on social media and many letters to the editor to Mid-Valley Media.

The Corvallis Clinic is considering switching original Medicare to a "nonparticipating provider" status.

The Corvallis Clinic sent a letter to all original Medicare patients on file, prompting them to consider changing to Medicare Advantage to "maintain the level of care" patients are receiving.

The reason behind the possible switch is financial stress within the health care industry, the letter stated.

"In some cases, the reimbursement levels for an original Medicare patient may not even cover the operating cost of seeing that patient," the letter read.

'Frightening'

The medical group has patients all throughout the mid-Willamette Valley, serving Benton, Linn and Lincoln counties.

Many of those patients took to the NextDoor app and other social media platforms to try to find answers and express their feelings.

"To anyone depending on Medicare, this is a frightening letter," said Gene Dannen of Corvallis, a patient of Corvallis Clinic for more than 20 years.

The letter indicates the clinic may be switching the status to "nonparticipating provider," words that Dannen believes can be misleading to patients. He said many people are reading that and believing they have to switch providers and leave the Corvallis Clinic, he said by phone.

The way he first read the letter, Dannen thought it meant the clinic would no longer accept original Medicare patients at all.

But according to Corvallis Clinic Marketing Communications Coordinator Sarah Wai, that is not the case.

"We are not saying that we will no longer be seeing original Medicare patients," Wai said.

Misunderstandings

She acknowledged there have been a lot of misunderstandings surrounding the letter with the Corvallis Clinic receiving a lot of calls from people with questions.

Despite that, she said clinic leaders do not plan to send out a follow-up letter.

The letter was sent with the intention "to give Medicare patients notice that we were considering a change," Wai said.

But when and if that change is happening remains unclear.

Wai said the decision is yet to be made by the board of directors. The change would happen after 2023, she added, even though the letter urges patients to enroll now to avoid "limitations and inconveniences."

The cost of Medicare Advantage coverage isn't necessarily more expensive and is often a little below or above what patients are paying for original Medicare, Wai said.

"Typically, Medicare Advantage provides patients with more coverage," she said, adding a caveat that it depends on the individual's needs.

Resources

If the Corvallis Clinic ultimately decides to change its status, things may get more complicated for patients with original Medicare.

"Original Medicare patients may have to pay out of pocket and get personal reimbursements from Medicare," Wai said.

Because each individual case is different, it's hard to generalize, she said. That's why the letters went out in advance of the possible change, to inform patients of their options, she said.

Wai said there are plenty of resources available, such as Statewide Health Insurance Advisors. SHIBA provides free, unbiased confidential assistance with Medicare and health care choices, according to its website at https://shiba.oregon.gov/Pages/index.aspx.

"We are telling patients to speak with primary care providers and insurance agents to figure out what's best for them."

Providers at the Corvallis Clinic are "payer agnostic," said Wai, but they can help direct patients to resources like SHIBA and the Medicare FAQ page on the Corvallis Clinic website at https://www.corvallisclinic.com/medicare-faq/.

Corvallis resident Laurie Russell has done some research and spoken to an insurance broker. But she is still concerned, both for her coverage and her 93-year-old mother's care.

Making sense of it

Russell said she too, had trouble making sense of the letter in her mailbox. She can envision a scenario in which the vagueness was intentional.

She believes that the Corvallis Clinic is waiting to see how many people will switch plans from original Medicare to Medicare Advantage before the health care provider makes a decision about being a "nonparticipating provider."

Russell's current original Medicare plan includes a supplemental coverage that covers her mother's specialty services. She is concerned that if she switches to an Advantage plan, she will lose coverage for her mother's chronic condition, she said by phone.

It's a lot to navigate, and Russell is especially concerned for older adults trying to figure out what to do, especially when many are not on the internet.

Although the letter gave some resource options, Russell said that many of the resources aren't very accessible for older generations.

"My 93-year-old mother wouldn't know how to do this if she didn't have me," she said.

Russell is frustrated and feels that issues like this are a call for broad access to health care insurance.

"I wish we had health care coverage that covered everyone like every other developed country in the world," she said.

Overriding trends

Retired physician Mike Huntington said Corvallis Clinic's move falls into a larger trend he has watched in the health care industry.

He first noticed there was a problem when his practice noticed more patients with advanced cancers despite advances in early diagnoses. The problem, he said, had to do with insurance coverage.

"It makes our health care a commodity," he said.

Since then, Huntington has been an advocate for Medicare for All.

When Huntington opened his letter from the Corvallis Clinic, he said he was saddened, but not surprised.

And now Huntington is concerned about his own coverage.

Huntington was a patient of primary care for 20 years, and now is a patient of specialty care at the Corvallis Clinic. He worries he won't be able to receive specialty care.

"Medicare Advantage may have some attractive perks, but it may not be appropriate with some patients with chronic conditions," he said.

Huntington believes Corvallis Clinic has been "backed into a corner." The letter references a financial struggle within the industry. He reads the letter as trying to get as many people as they can to switch now, he added.

He advises patients to call their providers to make sure they are still taking their insurance and speak with insurance brokers at this time to figure out next steps.

Huntington added he has a lot of respect for the Corvallis Clinic and feels its leadership shouldn't be blamed for trying to survive. He wishes, though, it would instead critique the system that has allowed this to become a normal pattern for health care.

He hopes the community can come together to advocate for stronger original Medicare coverage.