Seniors Lose Doctors Because of Disagreement Between Companies

By Candace Kelley

Many seniors have their insurance plans all mapped out.

“We’ll both go to Medicare and buy a supplemental insurance,” said Don Bryker of Neptune.

Supplemental insurance like United Healthcare’s Medicare Advantage is a popular choice for many New Jerseyans. Medicare Advantage is government-funded but unlike Medicare, which allows consumers to see any doctor. It’s a managed care plan with a network of providers.

But a dispute between United Healthcare and Meridian Health over how much the insurance company would reimburse the hospitals for services provided has resulted in Meridian Healthcare and a limited number of physicians being dropped from the Medicare Advantage Network.

“Routine physicals, annual foot care, that’s excluded from Medicare coverage. Dental, visions, hearing those are all added benefits of a Medicare Advantage but not those advantages that will go away,” said insurance advisor Robert Osmun.

This means about 8,000 Medicare Advantage consumers for now are left without doctors they had been working with.

South Jerseyans are largely affected because Meridian is located near the beach in South Jersey and owns several medical centers and hospitals. Those who were going to be affected received letters form the hospital 3O days before the contract was terminated.

In a statement, United Heatlhcare says, “Our Medicare Advantage members continue to have broad access to hospitals and physicians across New Jersey to meet their health care needs, and we will work with them to ensure access to those providers.”

The company says that includes helping members in active treatment with continuity of care requests. Meanwhile, insurance advisors say changes like this aren’t uncommon, and things could change yet again.

“The window is never closed. A lot of times you see a contract terminate, then six to eight months later you see a hospital join the network again,” said Osmun.

In the meantime, he says seniors have the option of waiting for the open enrollment period and shop for a plan that includes the doctors they want. That open enrollment begins on Oct. 15, but they won’t have access to their new plan and the doctors they want until January 2015.