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Have You Been Terminated by a Medicare Advantage Plan?

    • ISSUE-7-What-Physicians-Need-to-KnowThe Illinois State Medical Society continues to offer guidance to physicians who find themselves terminated from Medicare Advantage (MA) plans. We are particularly concerned about instances when a physician is unilaterally terminated from, or is unable to contract with an MA plan. These scenarios can be confusing and troublesome for patients who have had longstanding relationships with these physicians. Unfortunately, while MA plans are required to clearly disclose plan limitations to seniors prior to their signing up for coverage, some seniors may find themselves in the predicament of no longer being able to see their preferred physician(s) due to not fully understanding the plan limitations.

      It is critical for physicians to know their rights and their options if they wish to continue seeing their existing patients and/or new patients who have enrolled in MA plans. Physicians may begin the plan year believing they are contracted with particular MA plans through All Products Clauses that are generally listed within their managed care contracts, only to discover later that they've been terminated from one or all product lines including MA plan(s). Similarly, MA plans may refuse to contract with a particular physician or group. 

      In this scenario, seniors and other health care consumers do not understand that merely being covered by a health insurance plan does not guarantee they will be able to keep seeing their preferred physicians. These situations may cause terminated physicians to worry - about the continuum of care for their patients, about allegations of patient abandonment, and about increased medical liability - especially when patients find themselves having to explain their entire medical histories to someone new, or to have their medication regimen altered (even when a particular therapy has been found to be effective). 

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