JustCare

Tag: Denial

  • Sen. Warren and Rep. Jayapal urge CMS to end Medicare Advantage overpayments, punish bad actors

    Sen. Warren and Rep. Jayapal urge CMS to end Medicare Advantage overpayments, punish bad actors

    Ahead of the Centers for Medicare and Medicaid Services’ (CMS’) release of proposed payment policy for Medicare Advantage plans, Senator Elizabeth Warren and Representative Pramila Jayapal sent a letter to the Centers for Medicare and Medicaid Services detailing ways the administration could wipe out a projected $100 billion in overpayments to MA plans this year alone. Among other things, the letter proposes ending contracts with MA plans that violate their duty to cover Medicare benefits.

    “It is imperative for [Medicare] to rein in these abuses and protect Medicare coverage for the seniors and people with disabilities who rely on it,” say Warren and Jayapal. Last month, Senator Warren wrote CMS to start collecting critical data needed to oversee the Medicare Advantage plans.

    Thirty-one million older adults and people with disabilities are enrolled in Medicare Advantage plans. These health plans cost taxpayers $500 billion last year. But, substantial evidence indicates that the government overpays insurers offering these plans tens of billions of dollars each year; and, some, if not many, of these MA plans inappropriately deny and delay care to their enrollees, especially care for people with complex and costly conditions.

    The Biden administration has taken some steps to end some of the overpayment abuses. But, many experts believe there’s a lot more to be done. Mark Miller, former director of the Medicare Payment Advisory Commission, says “If [the Centers for Medicare and Medicaid Services] backs down … then the beneficiary and taxpayer lose.”

    CMS gave the insurers immunity from overpayments detected over seven years of audits. CMS now plans to conduct more auditing of MA plans’ billing processes. Warren and Jayapal are looking for payment policy changes as well as audits. For example, they want the government to adjust payments to MA plans because their enrollees are healthier than enrollees in Traditional Medicare.

    The five-star quality rating system for MA plans also needs an overhaul. People cannot rely on the star-rating system as an indicator of whether an MA plan inappropriately denies care or has a narrow network that undermines their ability to get good care. Yet, the government pays insurers more for MA plans with a 4 or 5 star-rating.

    Moreover, some data show that some MA plans provide their enrollees fewer benefits than they would get in Traditional Medicare, even though they are legally required to cover the same benefits. CMS has not penalized plans that inappropriately deny care. Warren and Jayapal want CMS to hold them accountable and end their contracts.

    In some instances, UnitedHealth Group has denied rehab care to patients in critical need of rehab, based on computer algorithms, to the detriment of their enrollees’ health and well-being. Even though CMS said it may punish insurers who violate their contracts by wrongly denying care, it has yet to do so.

    CMS has ended contracts with Centene Medicare Advantage plans in Arizona and North Carolina because their star-ratings were three or below for three years running.

    Here’s more from Just Care:

  • Are lower income individuals enrolling in Medicare Advantage for the wrong reasons, at their peril?

    Are lower income individuals enrolling in Medicare Advantage for the wrong reasons, at their peril?

    Medicare Advantage enrollment is up, and people with low incomes and people of color are enrolling in Medicare Advantage at disproportionate rates. A new study published in JAMA by Avni Gupta, BDS, MPH, Diana Silver, PhD, David J. Meyers, PhD; et al. finds that lower income individuals are often drawn into Medicare Advantage because of ads promising vision and dental benefits. The authors consider whether this is a good reason for people to enroll in a particular plan or whether these people are more likely to end up in Medicare Advantage plans that threaten their access to care.

    Many people of color and low income individuals rely on misleading marketing to make their choices, which is highly problematic.

    The worst performing Medicare Advantage plans are largely responsible for tens of thousands of unnecessary deaths a year. But we don’t know which ones they are. The data is not available. People who enroll in a Medicare Advantage plan take a gamble that if they develop a serious condition they will get the care they need.

    The American Hospital Association (AHA) has urged the government to step in to protect people in Medicare Advantage. The AHA explains the harm to patients from prior authorization rules that lead to delays and denials of critical care. So does the HHS Office of the Inspector General. The Centers for Medicare and Medicaid Services, which oversees Medicare Advantage, does not have the resources to conduct adequate oversight and enforcement.

    In this study, the data show that Black Americans were more likely to sign up for MA plans with dental or vision benefits than White Americans. People with incomes no more than twice the federal poverty level also were more likely than higher income individuals to enroll in Medicare Advantage plans with dental benefits.

    It’s not clear from the study whether the MA plans with dental and vision benefits have better or worse health outcomes. As it is, they have on average 43 MA plans to choose from, all differing in ways that are impossible to assess, including with respect to premiums, deductibles and out-of-pocket caps, which are knowable, and with respect to typical out-of-pocket costs, denial and delay rates, and mortality rates, which are not knowable. What is clear is that people who enroll in a Medicare Advantage plan take a big gamble with their health and well-being that they will be able to get the care they need should they develop a complex and costly condition.

    Vision and dental benefits in MA plans tend to come with high out-of-pocket costs and to be restricted. While data is limited, it appears that most people do not end up using these benefits, either their dental and vision needs are not covered or they can’t find a provider to see them or their costs are unaffordable.

    What will happen to dental and vision benefits when the government addresses overpayments to MA plans? Based on prior research, changes to these benefits are likely to be minimal. One researcher found that with $1,000 less to spend, MA plans increased monthly premiums by $5. There is also a five percent risk that vision or hearing benefits would end.

    What will happen to Medicare if the government does not address overpayments to MA plans? It is not unlikely that Traditional Medicare will wither on the vine and that insurers will take over all of Medicare. Because they cost so much and often delay and deny care inappropriately, more people with Medicare are likely to be unable to afford or get the care they need, endangering their health and well-being.

    If you’re in a Medicare Advantage plan, take advantage of the Medicare Advantage Open Enrollment period, which runs through March 31. If you can, switch to Traditional Medicare if you want to ensure easy access to the care you need.

    Here’s more from Just Care:

  • Elevance Health sues to undo changes to Medicare Advantage star-rating system

    Elevance Health sues to undo changes to Medicare Advantage star-rating system

    For years, the Centers for Medicare and Medicare Services (CMS) has been giving additional money to Medicare Advantage plans that get four and five-star ratings. The goal was to promote quality, but the reality is that the five-star rating system is a farce and needs an overhaul. CMS has taken some steps to overhaul it but Jackob Emerson reports for Becker’s that Elevance Health is suing HHS for “unlawful, and arbitrary and capricious” methodology changes to how Medicare Advantage and Part D star ratings are calculated.

    Don’t be misled by the government’s Medicare Advantage star-rating system. As of now, Medicare Advantage plans with four and five stars could have high denial rates, high mortality rates, endless prior authorization requirements and narrow networks that undermine access to care.

    CMS uses 40 quality measures to rate Medicare Advantage plans, but these measures don’t give you a good clue as to whether a Medicare Advantage plan will actually cover the care you need, when you need it from physicians and hospitals you want to use.

    CMS has gotten a bit stricter in giving out four and five-star ratings. And, Elevance says it is losing revenue because fewer of its Medicare Advantage plans are getting at least four stars.

    For reasons that are unclear to me, CMS cannot change MA plan star-rating scores more than five percent from one year to the next. Somehow, Elevance claims that CMS did not abide by this restriction. Elevance therefore asks the court to require CMS to recalculate all scores for purposes of star-ratings for 2024.

    Here’s more from Just Care:

  • UnitedHealth’s denials of critical rehab services is under investigation

    UnitedHealth’s denials of critical rehab services is under investigation

    Stat News reports on United HealthCare’s secret rules that deny Medicare Advantage enrollees critical and costly rehab care when they most need it. UnitedHealth literally singled out people with cognitive impairments and nursing home residents for exclusion from coverage of rehab services, even though they needed these services. But, Congressional and administrative scrutiny on UnitedHealth’s practices appear to be affecting the insurer’s behavior for the better, at least for now.

    Stat News obtained internal UnitedHealth documents that advised clinicians who worked for the insurer to deny people care that their treating physicians said was medically necessary. But, in November 2023, the clinicians’ managers told the clinicians that they could consider the individual needs of each patient to determine whether rehab services were medically necessary. Not surprisingly, that directive came on the heels of a Congressional investigation into UnitedHealth’s practices and the Centers for Medicare and Medicaid Services (CMS) saying that it was about to look more closely at UnitedHealth’s denials of services to its Medicare Advantage enrollees.

    Stat News has been reporting on the use of AI by UnitedHealth and other insurers offering Medicare Advantage plans to deny care without regard to patient needs. According to some experts, UnitedHealth has been denying care based on rules that have no evidence base. For example, UnitedHealth’s AI algorithms for determining whether care is medically necessary apparently denied rehab care across the board to most nursing home residents rather than looking at people’s individual care needs as required under Medicare law.

    Some of these nursing home residents were recovering from strokes, big falls and cancer and desperately required rehab services to regain function. Yet, while Medicare Advantage enrollees are supposed to have coverage for the same benefits as people in traditional Medicare, they too often do not.

    Even if you are not enrolled in a UnitedHealth Medicare Advantage plan, you may still have cause for concern. Many Medicare Advantage insurers use NaviHealth’s AI algorithms to deny rehab care. In total, around 15 million Medicare enrollees are at risk.

    NaviHealth has denied the charges against it, claiming that it does review “complex” cases to determine medical necessity. It also claims that the change in protocols to give clinicians more discretion in approving care was unrelated to Congressional and CMS investigations into its practices. “Following a standard review of protocols, we identified an opportunity to simplify care approvals in certain clinically complex conditions that do not require escalated review by a physician medical director for approval. Any adverse coverage decision is made by physician medical directors based on Medicare coverage criteria and supporting clinical records.”

    Unfortunately, CMS does not begin to have the resources or the power to hold UnitedHealth and other Medicare Advantage insurers accountable for their bad acts in meaningful ways. Consequently, people enrolled in these Medicare Advantage plans who end up needing costly and complex care could be at serious risk. Moreover, UnitedHealth and other Medicare Advantage insurers can change their practices at any time to restrict care access, with near impunity, as CMS is not likely to know and penalties are at most mild.

    Here’s more from Just Care:

  • CMS can’t oversee AI denials in Medicare Advantage

    CMS can’t oversee AI denials in Medicare Advantage

    Congressman Jerry Nadler, Congresswoman Judy Chu and 28 other House members recently sent a letter to the Centers for Medicare and Medicaid Services (CMS) urging CMS to assess AI denials in Medicare Advantage. If only CMS could do so effectively and in a timely manner. Not only does CMS lack the resources to do the requisite oversight at the moment, but when it finds Medicare Advantage plans are inappropriately denying care through AI, CMS appears to lack the power to punish the insurers in a meaningful way.

    Bottom line: It seems unlikely that CMS can rein in the Medicare Advantage plans’ use of AI to deny claims at eye-popping rates, even if the insurers offering Medicare Advantage plans deny care without regard to enrollees’ particular conditions, as required.

    In their letter to CMS, the members of Congress express concern about CMS’ Medicare Advantage and Part D prescription drug prior authorization requirements in its 2024 final rule.

    What’s happening exactly? NaviHealth, myNexus and CareCentrix provide Medicare Advantage plans with AI software to restrict coverage based on artificial intelligence. The insurers who rely on AI claim that they also review claims based on patient needs. But, former NaviHealth staff argue to the contrary. Mounting evidence suggests that the lives and health of some Medicare Advantage enrollees are endangered.

    Because CMS does not prevent insurers from using AI to deny Medicare Advantage coverage, members of Congress recognize the challenge for CMS to monitor the use of AI and ensure that claims are properly processed. “Absent prohibiting the use of AI/algorithmic tools outright, it is unclear how CMS is monitoring and evaluating MA plans’ use of such tools in order to ensure that plans comply with Medicare’s rules and do not inappropriately create barriers to care,” the members wrote.

    The insurers will always claim that AI is not making the denial decision, which is true. The insurers are. But, they appear to be exercising little if any independent judgment in many instances. So, the question remains whether the insurers are determining medical necessity based on the medical needs of their enrollees, as they should be. What’s clear is that though Medicare Advantage plans are legally required to provide the same coverage as traditional Medicare, they do not. 

    To help ensurer appropriate oversight of the insurers’ use of AI, among other things, the members of Congress propose that CMS:

    • Require MA plans to report prior authorization data including reason for denial, by type of service, beneficiary characteristics (such as health conditions) and timeliness of prior authorization decisions;
    • Compare the AI determinations against the actual MA plans’ determination;
    • Assess whether the AI/algorithms are “self-correcting,” by determining whether, when a plan denial or premature termination of services is reversed on appeal, that reversal is then factored into the software so that it appropriately learns when care should be covered.

    Here’s more from Just Care:

  • Medicare Advantage: Denials and more denials, some deadly

    Medicare Advantage: Denials and more denials, some deadly

    Remember the line about the bridge in Brooklyn? “If you believe that, I have a bridge in Brooklyn to sell you.” Don’t fall for the con. It applies in spades to all the hype about Medicare Advantage. You might save a little money, but it could cost you your life. No joke.

    The families of two Medicare Advantage enrollees are suing UnitedHealthcare, in a proposed class action suit, for wrongly cutting off their medically necessary care in a rehabilitation facility. The enrollees have died. The families allege that UnitedHealthcare used artificial intelligence to deny their relatives care, without appropriate attention to their relatives’ particular care needs, as required under Medicare rules. UnitedHealthcare  denies any wrongdoing.

    You always can save money by not having health insurance or not getting health care when you really need it. That’s effectively what’s happening to some people in Medicare Advantage plans. When Medicare Advantage enrollees get sick–when they really need health insurance to cover their health care–they could be out of luck, without the coverage to meet their needs. And, that goes for people in Medicare Advantage HMOs with restricted networks, as well as people in PPO’s, with more open networks.

    The American Hospital Association just sent another letter to the Centers for Medicare and Medicaid Services, CMS, which is charged with overseeing the insurers offering Medicare Advantage, urging CMS to enforce rules intended to keep the Medicare Advantage plans from inappropriately denying care. The problem is that the rules have no teeth. So, corporate health insurers are flouting them, denying care to people whose care would be covered in Traditional Medicare.

    An earlier letter from the American Hospital Association to CMS documented the serious harm some insurance companies are inflicting on Medicare Advantage plan enrollees needing critical hospital care. 

    CMS appears to believe that its ability to protect people from Medicare Advantage plan bad actors is circumscribed, even when the insurers offering Medicare Advantage are clearly violating their contractual obligations. Consequently, people enrolled in Medicare Advantage plans are taking a huge gamble. If they need costly care, it’s not clear they will get it.

    There could be some insurers offering Medicare Advantage that are doing right by their enrollees. But, if there are, no one knows which ones. Do you really want to roll the dice with your health and well-being?

    Right now, during the Medicare Open Enrollment period, you should seriously consider making a switch to Traditional Medicare. If you have Medicaid, you will have almost all your costs covered. Even if you don’t have Medicaid, if you don’t need a lot of health care, you will have few out-of-pocket expenses. If you want good protection from financial risk, you will need to buy supplemental coverage, which can be costly and hard to come by. But, in most states, Medigap plans K and L are low-cost. Even without Medigap coverage, your out-of- pocket costs are not likely to be any higher than your out-of-pocket costs in Medicare Advantage, which can be as high as $8,850 for in-network care alone. And, in Traditional Medicare, you can be sure that you will get the care you need when you need it.

    The Biden Administration could protect people in Medicare Advantage immediately, as it figures out how to ensure that the Medicare Advantage insurers are accountable for their bad acts. The Administration could, through executive order, require CMS to put an out-of-pocket cap in Traditional Medicare. The cap should save Medicare money, as the government is so wildly overpaying the insurers offering Medicare Advantage plans, that giving people the ability to enroll in Traditional Medicare without having to buy supplemental coverage would guarantee them access to the care they need at a lower cost to the Medicare program.

    Here’s more from Just Care:

  • Reps and Dems angry about care denials in Medicare Advantage

    Reps and Dems angry about care denials in Medicare Advantage

    Robert King writes for Politico about the Republican and Democratic anger directed at insurance companies for denying care inappropriately to older adults and people with disabilities enrolled in Medicare Advantage plans. Complaints to members of Congress from people enrolled in Medicare Advantage, as well as from health care providers treating people enrolled in Medicare Advantage, are on the rise. And, for good reason.

    Now, more than half the Medicare population is enrolled in a Medicare Advantage plan, a health plan administered by a corporate health insurer. Whether people have been steered to a Medicare Advantage plan by a friend, an employer, a union or Joe Namath, no one likely told them that they were putting their health and well-being at risk. No one likely told them that insurers offering Medicare Advantage plans can and do too often deny or delay critical care with impunity, as a way to maximize profits.

    Most people don’t appreciate that the government cannot ensure that Medicare Advantage plans cover their care. And, the Centers for Medicare and Medicaid Services, which oversees Medicare Advantage, is hard-pressed to warn people about the Medicare Advantage bad actors, let alone cancel their contracts.

    Senator Ron Wyden, Chair of the Senate Finance Committee, recently held a hearing focused on the misleading marketing in Medicare Advantage. His takeaway: “It was stunning how many times senators on both sides of the aisle kept linking constituent problems with denying authorizations for care.” What’s truly stunning is that corporate health insurers offering Medicare Advantage plans have been denying care inappropriately for years, and it’s only now that Congress is waking up to this horror show, which is literally leading to tens of thousands of unnecessary deaths each year, according to one academic study.

    Corporate health insurers use prior authorization tools, which require insurer approval in order to ensure coverage, as a way to delay urgent care as well as to deny it. Insurers also use artificial intelligence or AI to make sweeping acr0ss-the-board denials of care, without regard to particular patient conditions, in violation of their Medicare contracts. Stat News recently reported on the grave harm to patients entitled to rehabilitation services when enrolled in some Medicare Advantage plans.

    Here’s more from Just Care:

  • UnitedHealth deprives members of critical rehabilitation care

    UnitedHealth deprives members of critical rehabilitation care

    A new investigation by Bob Herman and Casey Ross, reported in Stat News, reveals that UnitedHealth, Humana and other insurers are using algorithms to deny critical rehabilitation care to people in Medicare Advantage plans, in violation of Medicare rules and endangering their members. (You can bet real money that people needing all kinds of costly care are facing wrongful denials.) The report explains that these insurers are using A.I. software to keep people in critical condition from getting the medically necessary rehab services that people with Medicare get in Traditional Medicare and that the government pays these insurers to provide their enrollees.

    UnitedHealth pushed its staff to adhere to the treating decisions of its NaviHealth software, without regard to the specific needs of rehab patients, endangering their health and well-being. Through these denials, UnitedHealth can keep more of the money that the government gives them to provide care. Not surprisingly, United’s NaviHealth software severely restricts or withholds needed care.

    NaviHealth staff were fired or quit when they could not tolerate the medical decisions UnitedHealth was pressuring them to make based virtually exclusively on its NaviHealth software. UnitedHealth continues to claim that it is giving its members all the care they need.

    Senior former officials at Medicare designed the NaviHealth product, which boosts UnitedHealth’s revenue by hundreds of millions of dollars a year. The Centers for Medicare and Medicaid Services, which oversees Medicare, is investigating, but it is clear that it lacks the resources and the power to hold the large insurers offering Medicare Advantage plans to account. It never has. President Biden needs to step in with an Executive Order.

    Advocates are pressuring members of Congress and the administration to stop these insurers from enrolling new members and, at the very least, to warn enrollees about the risks to their health if they are enrolled in Medicare Advantage plans offered by these insurers. To date, CMS has done little. In fact, the information it provides on Medicare options is extremely misleading, steering people to Medicare Advantage plans that could endanger their health. Several members of Congress, including Mark Pocan, Katie Porter, Pramila Jayapal, and Jan Schakowsky, have sent letters to CMS asking it to hold the insurers to account.

    Here’s more from Just Care:

  • Why health insurers deny necessary care and get away with it

    Why health insurers deny necessary care and get away with it

    If you’re wondering why insurance companies deny necessary care and get away with it, it’s not only that the insurers are pulling all the strings and have become too big to fail. It’s that different doctors often have different opinions about what is medically necessary. A new report from the Center for Improving Value in Health Care focuses on the health care that people get that the Center says is not medically necessary, driving up health care spending, reports Markian Hawryluk for KFF Health News.

    The amount spent on unnecessary care or “low value” care in Colorado, as reported–$134 million in 2022–seems relatively small. The Center says it is the tip of the iceberg. But who is to judge what is low-value care? The health insurance companies should not be the judge when they profit from denying care.

    There is tremendous risk in turning authority over treatment decisions from physicians to insurance companies, as Medicare has done through the Medicare Advantage program. Where is the value in handing buckets of money to health insurance corporations who can deny coverage for low, medium and high value care without justification, in secret, largely with impunity, in order to maximize profits?

    And, we continue to hear horror stories of the health insurers denying needed care through AI algorithms and staff physicians who earn bonuses when they don’t refer patients for costly specialty care. Why would we trust the insurance companies and their staff to get coverage decisions right when they have no understanding of particular patient conditions and an incentive to deny care? Read this post on how UnitedHealth is using AI to deny rehab care to vulnerable older adults without regard to their particular conditions and weep.

    Of course, there is no perfect payment system. The Center for Improving Value in Health Care appears to like the idea of giving insurers buckets of money to cover care. But, rather than giving insurers the discretion over these treatments, isn’t the fix to have national policies, publicly vetted, about what is covered and not covered? If opiates, antipsychotics and screenings for Vitamin D deficiency are really unnecessary in most cases, why are insurers covering them?

    A capitated payment system–one in which the insurers are handed money upfront to “manage” care–simply changes the incentives, disregarding physician opinions, working against patients, and rewarding insurance companies for giving less care or for denying care inappropriately. And, corporate health insurers operate in a proprietary or secret system. Researchers can’t even learn whether what insurers are doing when they deny care is endangering people’s lives or helping them. How does that add value?

    What’s crystal clear is that if we are going to improve the health care system, we need to collect and review patient data. We need to know what is working and not working. We need to know in real-time what’s happening to protect people from insurance companies that put their profits first. And, we need to be doing what other wealthy nations do: Dictating all the terms of coverage, removing discretion over coverage decisions from insurance companies, so that people can count on getting the care they need without delay and are not forced to gamble with their health.

    Here’s more from Just Care:

  • Underpayments lead hospitals and specialists to cancel Medicare Advantage contracts

    Underpayments lead hospitals and specialists to cancel Medicare Advantage contracts

    Ken Alltucker reports for USA Today on how insurers offering Medicare Advantage plans are underpaying hospitals and specialists. Consequently, these health care providers are dropping their Medicare Advantage contracts. It’s hard to see how this persisting issue can be solved given the corporate health insurers’ ability to use their own proprietary claims processing software, which makes oversight near impossible.

    Since Medicare Advantage plans legally must cover the same benefits as Traditional Medicare, they should be required to to use the same claims processing software as Traditional Medicare to ensure they do. They should also be required to pay hospitals and specialists the same rates as Traditional Medicare.

    Traditional Medicare rates are significantly lower than commercial insurance rates because, unlike Medicare, which uses its enormous leverage to set fair rates with providers, commercial health insurers are generally unwilling or unable to negotiate low rates for people under 65. But, Congress allow Medicare Advantage insurers to pay providers even lower rates than Traditional Medicare. So, the insurers sometimes will only pay lower rates; consequently, they can keep top quality providers out of their networks and increase their profits. Narrow networks keep people with costly conditions from enrolling or remaining in a Medicare Advantage plan.

    The USA Today story feeds off of other stories in Becker’s Hospital, MedPage Today and Kaiser Health News, documenting the financial problems and patient safety concerns that hospitals are dealing with because Medicare Advantage plans are undermining their ability to provide good patient care and underpaying them. When these hospitals cancel their Medicare Advantage contracts, tens of thousands of patients face major care disruptions.

    The patient care disruptions mean that patients need to find new doctors and hospitals or pay out of network to continue to get care from the same providers. The Centers for Medicare and Medicaid Services, which oversees Medicare, can step in to help patients when there are “significant network changes,” but it is not clear how often or whether it ever does.

    It’s likely that the disputes that USA Today documents are the tip of the iceberg. Even when Medicare Advantage plans agree to pay decent rates to hospitals, they can and do often refuse to pay the hospitals and other care providers what they owe them, cutting payments by as much as 30 percent. Hospitals then report losing tens of millions of dollars in revenue, while the insurers run away with the store. Moreover, hospitals also report inability to provide timely and necessary care to their patients in Medicare Advantage plans.

    The Medicare Advantage payment system is defective. The government pays the insurers upfront regardless of how much they spend on care. The government is not even able to monitor how much the Medicare Advantage plans spend on care effectively, in order to ensure enrollees are getting the benefits to which they are entitled. Not surprisingly, the Office of the Inspector General has found widespread and persistent failure on the part of the health insurers to pay for medically necessary care they should be paying for and that Traditional Medicare covers. That’s one way that the insurers profit.

    St. Charles Health system in Oregon tried and failed to resolve its disputes with insurers offering Medicare Advantage. As a result, it is cancelling contracts with Humana, HealthNet and WellCare. Its chief clinical officer said that unless it cancelled these contracts, their physicians would face restrictions on “patient care, longer hospital stays and administrative burdens.”

    Here’s more from Just Care: