‘26,000 could be affected’: St. Charles health system considering dropping Medicare Advantage

(Update: Adds video, comments from St. Charles, patients and insurance companies)

Hospital System Expresses Concerns, Enrolls in Traditional Medicare with Free Enrollment

BEND, Oregon (KTVZ) — The St. Charles Health System cites concerns about patient care, access and affordability and supports all Medicare Advantage plans, including Humana, Pacific Source, Healthnet and WellCare. It announced Monday that it is evaluating participation. Participants were encouraged to consider switching to traditional Medicare.

St. Charles continues to accept its own (or traditional) Medicare, which is federally funded and operated. Medicare Advantage plans are funded by the government, but operated by private insurance companies.

Henrik Jahn, president of Insurbend, said Friday, “I have about 1,500 customers with this policy, but about 26,000 people in Central Oregon could be affected. I know that,” he said.

There are four hospitals in the St. Charles Health System network.

The system is considering eliminating the Medicare Advantage insurance plan.

“Commonly, Medicare Advantage Plans interfere with patients and providers by delaying hospital discharge, impeding access, or aggressively retroactively changing financial circumstances after care has already been provided. It’s about making a choice that works for you,” Matt Swafford, St. Louis’ CFO, Charles, told NewsChannel 21.

Dr. St. Charles also cited administrative burdens, staffing shortages and delays in patient transfers as additional reasons for potentially withdrawing Medicare Advantage coverage.

St. Charles Chief Clinical Officer Dr. Mark Hallett explained further scenarios where insurance plans don’t cover what people think. “We also see patients being financially disadvantaged by being denied the services they needed, when they were already provided. Masu.”

According to PacificSource, 15,000 people are currently enrolled in Medicare benefit plans. “We also have about 2,500 members, called dual Medicare and Medicaid enrollees. They are among the most vulnerable people in our community, both low-income and I am often handicapped.”

“Because PacificSource is free, I think it’s going to be a financial burden for a lot of people,” said Kate Bailey, a Medicare Advantage policyholder who lives in Bend.

She has lived in Bend for over 20 years.

She is on the Medicare Advantage Plan, which provides dental, vision, and hearing services in addition to unexpected medical bills.

“If you don’t have that, you’ll have to go back to your health care facility and get a Part D. Getting something like other gap coverage would be very expensive and very time consuming. And customer service is I think it’s going to stop working, ‘the windows,’ Bailey explained.

Some wonder if there is a way for St. Charles to maintain Medicare Advantage coverage with less trouble. “My suggestion was, ‘Mike Gonzalves, a Medicare Advantage holder, began by saying, ‘We should use the Central Oregon Health Council as a negotiator to resolve these operational differences. If we don’t, we’ll be pushing the most at-risk people into health care facilities.” This area is at risk. ”

“Original care has no limit on individual out-of-pocket costs, but benefit plans should cap the patient’s out-of-pocket costs,” Jahn elaborates.

St. Charles expects a decision to be made by early fall, and patients will be notified at least 30 days in advance through their insurance companies.

“It’s critical to improve the care of scarce and invaluable health care providers and caregivers, and we need to be here to provide the care our communities need,” Swafford said. concluded.

Medicare coverage runs from October 15th through December 7th.

If St. Charles chooses to retire its Medicare Advantage Plan, the change could go into effect as early as this fall.

In a statement Monday, Dr. Steve Gordon, president and CEO of St. Charles University, said the decision to reassess participation in Medicare Advantage was well thought out, not only at St. He said the decision was made only after years of growing concern. Nationwide healthcare system.

“The reality of Medicare Advantage in Central Oregon is that it never delivers on its promises,” Gordon said. “Programs intended to promote seamless, high-quality care are instead fragmented patchwork of administrative delays, denials, and denials.” And frustration. The more severe the illness, the higher the hurdles you and your care team face. Our insurance partners need to improve, especially when nurses, doctors and other caregivers report high levels of burnout and job dissatisfaction. ”

St. Charles isn’t the only one to voice concerns about the Medicare Advantage plan. According to the American Hospital Association, the AHA is “increasingly concerned about policies in certain (Medicare Advantage) plans that limit or delay patient access to care, resulting in costs and burdens on the healthcare system. will be added.” In addition, Medicare Advantage Plans are under investigation for fraud, delayed coverage and denial of coverage.

“Patient outcomes vary depending on the type of insurance a patient has. We have to go through a lot to get it approved,” said St. Charles Chief Financial Officer Matt Swafford.

“We recognize that changing insurance options may be a temporary burden for Central Oregonians who are currently enrolled in Medicare Advantage plans, but ultimately it will help facilitate patient mobility. We believe it is the right choice for our patients and for the sustainability of our healthcare system into the future.” We hope to share this notice with seniors in Central Oregon so they have enough time to sign up for traditional Medicare during this fall recruitment period. ”

next step

The St. Charles Health System said it is evaluating Medicare Advantage contracts with Pacific Source, Humana, Healthnet and Wellcare this fall and winter.

If St. Charles is no longer considered “in-network” for these Medicare Advantage plans, patients currently enrolled in these plans will need to purchase another insurance plan to avoid changes in coverage and liability. Officials said they may have to choose a plan. Patients who may be affected by this change will receive a letter from St. Charles in the mail in the coming weeks.

“Central Oregon residents currently enrolled in Medicare Advantage plans will review their health insurance coverage during this fall recruitment period,” said Dr. I highly recommend that you consider switching to traditional Medicare.”

“If a patient has traditional Medicare, the doctor determines the patient’s care and medical needs. If the patient has a Medicare Advantage Plan, the insurance company Medicare Advantage Plans provide significant benefits for healthy people, but they eliminate barriers to care that patients may experience with MA plans if they are seriously ill or require hospitalization. We fear that they do not understand.”

Central Oregon residents interested in exploring insurance options should contact:

  • Oregon Senior Health Insurance Benefits Assistance (SHIBA), 800-722-4134, Option 2,
  • 800-Medicare (800-633-4227),
  • Central Oregon City Aging Council (541-678-5783),
  • or an insurance broker of your choice.

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