AARP MEDICARE ADVANTAGE MARKETING MISREPRESENTATION

[MahaJ87275]

It’s frustrating to see how AARP continues to promote United Healthcare (UHC) HMO plans in California, despite the issues that have left many seniors facing significant challenges. UHC recently pulled out of a key local network provider without properly notifying members during Medicare open enrollment. Now, seniors are discovering mid-year that their long-term doctors are out of network and are being billed as such since January 2024. This situation has caused a major administrative burden and, more importantly, a disruption in the healthcare services that our seniors depend on. It raises serious concerns about accountability and patient care.

As a volunteer SHIP counselor in San Mateo County, I’m seeing firsthand the impact of this breakdown, and it’s disheartening that AARP is not stepping in to address these issues. Seniors deserve better support and transparency from AARP & these Medicare Advantage plans.

[GailL1]

Changes in network providers happen in all types of health insurance since this is based on a contract and they have different dates of expiration - it even happens in Traditional Medicare.

I believe the cautionary instructions say to always check the network status of providers.  

There is no Medicare rule that says the sponsor insurer has to notify their beneficiary of these changes since it is easy for the beneficiary to check on such status.

[MahaJ87275 · Accepted solution]

A bulletin from the Center for Medicare Services dated January 2023 states as follows:

​“Your plan should make a good faith effort to give you at least 30 days’ notice that your provider is leaving your plan so you have time to choose a new provider. You’ll get this notice if you see that provider regularly or if it’s your primary care provider.” 

No such notice was given, although it is required by CMS.

Furthermore, UHC issued new cards for 2024 members showings the provider group they no longer had a contract with! 

we can argue over SHOULD. and MUST but I do not accept this argument as a way out for the HMO when pulling out of one of the largest medical groups in our area. 

[MahaJ87275]

lol, I a, new to this forum and have accidentally accepted a solution … whatever that means 😀

[GailL1]

Don’t worry about that - 

[GailL1]

And providers SHOULD also post this too but I don’t see how that would help cause the beneficiary still has to find another provider within their network.

With an Advantage plan, a beneficiary has specific enrollment periods when they can join, drop or switch plans.

Medicare.gov - Enrollment Periods

In the case of a provider leaving the network one should be able to use:

• Open Enrollment. Oct.15 - Dec 7
• Medicare Advantage Open Enrollment Period (if you’re already in a Medicare Advantage Plan). Jan 1 - March 31
• (Perhap) A Special Enrollment Period

You can also file a complaint or grievance  with Medicare.

Medicare.gov - Filing A Complaint

[MahaJ87275]

Yes, all correct. In this case the HMO had terminated the provider contract for 2024 and was aware of this during open enrollment but failed to notify members. The members got new cards following open enrollment showed the terminated medical group as their assigned group! Many members found out after March when out of network bills started to arrive that the contract was terminated. You bet we have been filing complaints with Medicare and getting SEP to change to another plan that covers their doctors. We have been dealing with this case by case but many members have no idea that they have this possibility . I expected AARP to step and lean on UHC to retroactively reprocess bills as in network as well as issues a group SEP for all those affected ( but I am not holding my breath!)

[GailL1]

Details are important .  Very interesting course there is probably more info needed to understand how all this came about - like who did the actual canceling of the plan participation - the provider or the insurer?  And Why?

You seem to be doing what you can under these unfortunate circumstances - hopefully those who are unaware of their options will review this plan carefully during open enrollment and make the necessary changes.

I don’t see AARP intervening at all - so please don’t hold your breath unless you have a CPR expert close by.  Disclosure after disclosure states their roll in this type of royalty partnering.  $$$$$ - Then there is this - dated August 2024 -

UHC Newroom 08/06/2024- UnitedHealthcare, AARP UPDATE Relationship Focused on Improving Older Americ... 

CMS could possibly force a group SEPbut that might mean going through legal channels - but it seems kind of late in the game now for this since OE is almost knocking at the door.  

[MahaJ87275]

Not late at all for a group SEP which would be effective Oct 1. Open enrollment means coverage start Jan 2025 …. 3 months with no medical care can be devastating for a senior. Thank you so much for that press release…very timely and as a bonus I was able to find Jenkins email address. She seems like a nice person to challenge and see if she would live up to this press release 😁.