HARTFORD, CT — The Connecticut State Medical Society is sounding alarm bells over Anthem’s decision to terminate Connecticut physicians from its Medicare Advantage Network. The termination of certain physicians doesn’t start until Jan. 1, but the organization worries it would compromise the care for tens of thousands of Medicare Advantage patients.
Medicare Advantage is an alternative to traditional Medicare and the doctors who were terminated are specialists, not primary care doctors.
“CSMS has substantial concern that patients will face transportation hardships in reaching physicians in Connecticut, therefore significantly compromising patient care, if they can find a physician of the same specialty accepting new Medicare Advantage patients,” wrote Matthew Katz, executive vice president of the organization, in a letter to Anthem Blue Cross and Blue Shield President Jill Hummel.
Anthem was unable to say how many consumers might be impacted by the decision.
In a statement, the company said: “We regularly review Anthem’s Medicare Advantage provider network to most effectively serve our members’ healthcare needs. We recently notified some specialty care providers that they will not be in our Medicare Advantage HMO Select Plan network, effective January 1, 2020.”
Katz said there’s a concern that “the unilateral network terminations by Anthem will leave a network of providers that is insufficient to provide adequate access for Medicare beneficiaries in Connecticut, especially in certain specialties in certain geographic areas of the state.”
Federal law requires Medicare networks to be adequate.
Anthem said they notified their members of the changes in advance of this year’s open enrollment period.
“We think it’s important that consumers are aware of this change so they can make informed decisions when considering Anthem’s 2020 Medicare Advantage plans,” an Anthem spokesperson said in a statement.
Katz said they are worried the current networks are limited.
“CSMS is concerned that many of the physicians remaining in Anthem’s network are no longer accepting new patients (have closed panels) or are no longer practicing or practicing more limited specialty care so that specialized care needed by these patients is not available. In fact, a quick check of the Anthem website highlights this for many specialties, including ophthalmology,” Katz said.
Katz has asked Anthem to tell his organization how many doctors have been unilaterally terminated.
“CSMS believes Anthem’s unilateral network terminations will unquestionably impact patient healthcare access in Connecticut and may, in fact, run afoul of several provisions of federal law relating to Medicare Advantage plans and network adequacy requirements, including those that speak to access requirements,” Katz said.
This is not the first time the Connecticut State Medical Society has been involved in a fight against a large insurance company.
In a similar situation with a different insurer in 2013, a federal judge agreed with two medical associations that UnitedHealthcare should stop dropping doctors from its Medicaid Advantage network. The insurance company appealed the decision and the federal Centers for Medicaid and Medicare Services said the networks were adequate.
This story first appeared September 10, 2019, in CT News Junkie | by Christine Stuart