Wednesday, November 13, 2013

Rhode Island Seniors on Medicare Advantage May Lose Access to Quality Eye Care and Surgery

Providence, Rhode Island (11/13/2013) It is estimated that about a 100 Rhode Island physicians have been dropped from UHC's Medicare Advantage plans also sold under AARP Medicare Complete.  Physician groups dropped include Koch Eye Associates, the leader in eye care and eye surgery in RI. Koch Eye Associates currently treats approximately 3,000 or 10% of the UHC’s Medicare Advantage members.  While United Health Care has the contractual right to shrink its network, in a small state such as Rhode Island it really threatens to limit access, quality and efficient care for seniors.

Why would UHC Medicare Advantage drop a group like Koch Eye Associates?

“We were shocked and disappointed to receive such a notice since we are a leader in eye care, have the only ophthalmic ambulatory surgery center in the state, follow best clinical practices and have an Electronic Medical Record (EMR) to ensure the integration of care both within our group and with physicians in the community. As a result of UHC’s terminations, seniors may have to travel to another state to get their care and even be forced to go to a hospital for cataract surgery,” commented Paul Koch, M.D., Medical Director of Koch Eye Associates.

Perhaps UHC made this decision without knowledge of the local market given a comment made by Jack Larson, UHC’s CEO of Community and State. “We are working to collaborate with a more focused network of physicians to help us provide higher quality and more affordable health care coverage to meet the needs of our members, and help them get more from their health plan benefits.”

Perhaps UHC is trying to reduce their membership of seniors since it appears they are not earning the same quality bonuses experienced by other Medical Advantage Carriers. They seem to be shifting blame to the government.  “Washington is squeezing payments to managed care plans like AARP's — collectively known as Medicare Advantage. The idea is to bring these private plans in line with the cost of original, fee-for-service Medicare,” said Larson.
Unfortunately UHC’s recent decision may make it necessary for many seniors to pay more out of pocket or switch doctors. “This is especially troubling for seniors who are on fixed incomes and are under treatment for serious eye diseases such as macular degeneration or diabetic eye problems that require continual care. Having any disruption of care at all has serious consequences. We will continue to see our patients with United Medicare Advantage. It is a shame that they won’t be getting the full benefit from their insurance,” further noted Dr. Koch.

What should seniors do?
1. Make sure you are evaluating your options for coverage.
2. Write to your state representatives asking them to advocate for maintaining access to quality providers and continuity of care.
3. Follow your physician’s advice on how to stay healthy and prevent illness since you are going to be faced with less choice and bigger health care bills in the future.

For additional information, contact:
Katie Carlisle, Medical Management Services Group, L.L.C., 733 Turnpike Street, N. Andover, MA 01845,, 978-470-8217

SOURCE: Medical Management Services Group, L.L.C.

No comments:

Post a Comment