Congresswoman Asks GAO To Investigate Medicare Advantage After Complaints

Congresswoman Rosa Delauro

Congresswoman Rosa Delauro

HAMDEN — About a dozen elderly people gathered in a conference room at Hamden Government Center on Friday to talk about their anger and frustration since UnitedHealthcare announced last fall it would cut thousands of doctors from its Medicare Advantage network.

They were further incensed when UnitedHealthcare and Yale-New Haven Health System did not reach a contract agreement, meaning the New Haven hospital will be dropped from the insurer’s Medicare Advantage network starting April 1.

Medicare Advantage is the version of government-funded Medicare that is offered by private insurers as an alternative, often with additional benefits and lower out-of-pocket expenses than traditional Medicare. The plans have been more expensive to federal taxpayers, on average, than traditional Medicare and the Affordable Care Act is scheduled to narrow the gap. As a result, insurers are offsetting the loss in government payments by changing benefits, premiums or physician networks.

The gathering was hosted by Congresswoman Rosa DeLauro, D-New Haven, who said she is asking the U.S. Government Accountability Office to investigate criteria for Medicare Advantage plans as set by the federal Centers for Medicare and Medicaid Services. DeLauro wanted to hear the experiences of people who have called her office to complain after UnitedHealthcare cut its Medicare Advantage physician network last fall.

The insurer has not said how many doctors it planned to eliminate, but the Fairfield County Medical Association has said it is 810 primary care physicians and 1,440 specialists across Connecticut.

“In light of the recent UnitedHealth Group network reductions, I am concerned that the oversight of Medicare Advantage plans may be lacking,” DeLauro wrote in a March 7 letter to Gene L. Dodaro, head of the GAO. UnitedHealth Group is the parent company of UnitedHealthcare.

She added that she is interested to learn how the Center for Medicare and Medicaid Services reviews whether seniors are receiving the quality care they deserve.

In addition to network cuts announced last fall, UnitedHealthcare and Yale-New Haven Health System failed to reach a contract agreement. As a result, the insurer said in February that Yale-New Haven will be cut from its Medicare Advantage network after March 31, with two exceptions. Bridgeport Hospital and Greenwich Hospital will remain in network. Other hospitals, such as Yale-New Haven and the Saint Raphael campus in New Haven, will be out of network starting April 1, and customers will face higher out-of-pocket expenses as a result.

“I’m 93. I don’t need this,” said Edwin R. Abrams, who was born in New Haven and has lived in the city his entire life except for three years in the Air Corps during World War II. He doesn’t want the hassle of going to Bridgeport Hospital instead of Yale-New Haven, which UnitedHealthcare suggests patients do.

Full Article & Source:
Congresswoman Asks GAO To Investigate Medicare Advantage After Complaints

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