AADA raises red flags on adequacy of Medicare Advantage networks with CMS
In a recent meeting with Centers for Medicare and Medicaid services (CMS), leaders from the American Academy of Dermatology Association (AADA) raised grave concerns about the adequacy of the UnitedHealthcare (UHC) and Humana Medicare Advantage (MA) networks and the negative effects these limited networks will have on patient access to care.
Brett Coldiron, MD, president of the AADA, Howard Rogers, MD, advisor to the AADA Private Sector Advocacy Task Force, Ray Welch, MD, and AADA staff specified that these narrowed networks will fail to meet the needs of patients, especially those most in need of care, and urged CMS to reevaluate the adequacy of the UHC MA networks, as well as increase transparency around the current termination criteria and re-examine the appeals process.
A recent history of narrowing networks
The AADA evaluated four UHC MA networks (Boca Raton, Fla., Cincinnati, Ohio, Hartford, Conn., and Providence, R.I.) to determine the network adequacy and found that — based on Medicare's own definition of network adequacy — UHC MA’s networks have an inadequate number of dermatology specialists and subspecialists, and that the network rosters are replete with errors, making it difficult for MA patients to identify dermatologists participating in their plan, and similarly difficult for dermatologists cut from the network to find participating dermatologists to whom they can transfer their UHC MA patients.
Additionally, the AADA found that the UHC MA physician network terminations were made “without cause,” and failed to provide meaningful appeal opportunities for physicians. The AADA believes that these terminations discriminate against the sickest Medicare beneficiaries because it appears that the primary factor in termination is cost of care provided to patients. The AADA also found that the MA plan sponsors did not provide adequate notice to patients in advance of the open enrollment period that their physician would no longer be a part of the plan’s network. The AADA sent a letter to CMS detailing these findings.
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AADA actions moving forward
Member guide: responding to network terminations
For more information, or to report a MA network termination, please contact David Brewster, assistant director, Practice Advocacy, at email@example.com or (202) 609-6334.