DeLauro, Blumenthal, Larson, Courtney, Himes, Hayes Press Anthem on Provider Terminations in Medicare Advantage Network
Today, Congresswoman
"By law, Medicare Advantage organizations are required to maintain and monitor a network of appropriate providers that is sufficient to provide adequate access to covered benefits and services to meet the needs of the population served," wrote the Members. "
"The individuals in our state most harmed by this decision include seniors and those living with a disability," continued the Members. "The network terminations will put far too many vulnerable beneficiaries at risk of failing to receive the care they need to maintain their health and prevent medical emergencies."
A full copy of the letter can be found below.
Ms.
President
Dear Ms. Hummel,
We are writing to express our concern regarding the recently announced provider terminations from
By law, Medicare Advantage organizations are required to maintain and monitor a network of appropriate providers that is sufficient to provide adequate access to covered benefits and services to meet the needs of the population served.
The individuals in our state most harmed by this decision include seniors and those living with a disability. The network terminations will put far too many vulnerable beneficiaries at risk of failing to receive the care they need to maintain their health and prevent medical emergencies. Furthermore, many of the providers remaining in the MA network are neither accepting any new patients nor are they providing their specialty at the level needed by many of the beneficiaries impacted by this termination.
We want to know why
* Please detail how
* How were providers selected for termination, and how many have been terminated? Please explain this decision-making process.
* What reason was given to providers for their termination from the MA network?
* How are providers able to appeal this decision? If they are unable to appeal or were not given a reason for their termination, what is the probability of a successful appeal?
* How many beneficiaries will be impacted by this decision?
* What notification has been given to beneficiaries enrolled in your MA program? If they have not been notified, when will they be notified?
* What assistance are you providing to beneficiaries to facilitate access to new providers, if their previous physician was terminated?
* Given Medicare Open Enrollment is quickly approaching, have you included information in your enrollment materials notifying current and prospective beneficiaries that your network of health care providers has drastically changed? Does this information inform beneficiaries that they have the ability to switch back to traditional Medicare during this enrollment period?
As you are well-aware, the open enrollment period for MA plans begins on
Thank you in advance for your consideration of our request. If you have further questions about our request, please contact
Sincerely,
Member of
Member of
Member of
Member of
Member of
UPDATE: H.R.4598 – To amend the Internal Revenue Code of 1986 to provide an exemption from FIRPTA for interests held by certain foreign insurance companies.
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