Oklahomans 65 or older or with certain disabilities are among our most vulnerable populations in health care. Yet, these patients are facing an alarming trend as their Medicare Advantage plans are dropped by hospitals, and insurers struggle with the financial feasibility of keeping those patients in-network. These network disruptions have a major ripple effect on patients, providers and communities.
In the past year, millions of patients nationwide have learned of losing their coverage with providers who previously accepted Medicare Advantage. In May, Comanche County Memorial Hospital in Lawton stopped accepting UnitedHealthcare Medicare Advantage plans. More recently, thousands of Tulsa- area patients were notified that their Medicare Advantage plans will no longer be in-network at the Saint Francis Warren Clinic.
Just last month in neighboring Texas, Blue Cross and Blue Shield of Texas dropped MD Anderson Cancer Center from its Medicare Advantage network, forcing patients to find new providers outside of the Houston cancer center.
The reasons for these changes differ, but there are common themes. According to Becker’s Hospital Review, hospitals and health systems have cited administrative challenges like excessive prior authorization denial rates and slow payments from insurers. For insurers, pulling away from the Medicare Advantage market comes down to money: these plans simply aren’t profitable in certain markets, especially where most of the population is Medicare-eligible. Additionally, despite posting record profits in recent years, Medicare Advantage insurers have systematically reduced the amount they pay to hospitals, physicians and other providers for patient services.
Regardless of the reasoning, one fact remains true: when these disruptions occur, patients bear the brunt of the hardship. Affected patients must choose new insurance plans, travel longer distances, search for new in-network doctors who may have a long waiting list — if they’re even accepting new patients at all — or even pay out of pocket if they wish to remain with their trusted providers.
Medicare patients are more likely to face challenges in driving further, have complex health issues, and often have higher needs for care. Additionally, they may encounter more problems when searching for a new provider. This trend is particularly concerning for rural Medicare Advantage patients, for whom access to care is already a significant issue.
Providers are growing increasingly frustrated. On one hand, Medicare Advantage can be incredibly burdensome, with delayed payments and prior authorizations making it difficult for physicians to provide the level of care their patients deserve. On the other hand, opting out of Medicare Advantage networks means losing long-term patients, many of whom have limited alternatives for in-network care.
As a radiation oncologist, I’ve seen the harm that insurance companies can inflict by denying or delaying care through various tactics. It’s why I’m passionate about advocating for laws that protect patients and providers; by reducing the administrative burden associated with insurance roadblocks like prior authorizations, we can ensure physicians are able to focus their time and resources on patient care. Advocating for strict adherence to timely reimbursement guidelines — such as Oklahoma’s Prompt Pay law — means these providers can afford to keep their doors open rather than waiting for months on end to be paid.
The current trajectory of Medicare Advantage is unsustainable, threatening the well-being of vulnerable patients and the livelihood of hardworking physicians. Policymakers and insurers must create a more sensible system that safeguards providers, allowing them to continue to deliver high-quality care to all Oklahomans while ensuring Medicare Advantage patients receive the care they need without disruptions.
EDITOR’S NOTE: Diane Heaton, M.D., is a board-certified radiation oncologist and serves as the medical director of the Northeastern Oklahoma Cancer Institute in Claremore and Oklahoma Cyberknife in Tulsa. She is the immediate past president of the Oklahoma State Medical Association.
