We have gotten a number of calls recently relating to your situation. At the beginning of a new year a provider may move in or out of insurance products as their practice dictates. This decision could be related to the amount the providers are paid by the insurance company or the timeframe it takes for the insurance company to pay the claims. It may be the rules the insurance company requires the doctors to comply with to get reimbursement.
The most common situation this year has been from University of Buffalo Neurosurgery, Inc. is no longer taking United Healthcare insurance products. Depending on the type of United Healthcare Insurance product you have will impact the outcome of this decision. Senior Life Matters did speak with University of Buffalo Neurosurgery, Inc. staff to clarify the coverage and be able to address this specific issue correctly.
If you are enrolled in a United Healthcare Medicare Advantage Choice Plan 1, Plan 3, Plan 4 or Patriot Plan, this practice will no longer see you as a patient at all. When enrolled in one of these Medicare Advantage plans, this practice will no longer participate in any way with these particular plans, so you will be required to see another Neurologist practice. You have the option of changing to an alternative insurance product altogether during the Medicare Advantage Open Enrollment Period which is January 1 to March 31 each year.
This open enrollment period is happening now and offers you an opportunity to enroll into an alternative insurance product that University of Buffalo Neurosurgery, Inc. does participate with.
If you have Original Medicare Part A & B and are enrolled into a United Healthcare Options Medicare Supplement Plan (Medigap) the answer to this situation is different. (Often individuals refer to these products as “AARP insurance”.) You can continue to see your physician at University of Buffalo Neurosurgery, Inc. who will bill your Original Medicare Part A & B. Medicare will then send the claim onto United Healthcare. The physician will bill you for the charges that Medicare does not pay. You will be expected to pay those Deductibles ($233) and 20% after the deductible. United Healthcare will pay those charges based on the type of Medigap Plan you have (Plan F, Plan G, Plan N, for example) back to you the patient with a check in the mail. Your cost shares in this scenario in the end will not change, but how you pay those cost shares will. You will pay the bill to the provider, University of Buffalo Neurosurgery, Inc and the United Healthcare sends the check for the co-insurance to you to deposit in your bank account.
If this sounds like something you don’t want to handle, remember that when you have a Medicare Supplement Plan, you can change your insurance company and your letter plan anytime you want during the year.
This situation with your Medicare Supplement Plan and University of Buffalo Neurosurgery, Inc is rare and we haven’t had this happen often in our area. The letter you received was upsetting, I understand. It seems like you can’t see your chosen provider anymore. But I hope I have clarified that you can still see that provider, but how the provider will be paid is a different procedure.
The situation where you have a Medicare Advantage Plan and your provider has chosen to no longer participate with that product is much more common. It is still upsetting, but you have choices and opportunities to move to another insurance product.
I hope this addresses your question about coverage and your physician. I also hope you realize you have ample opportunity in the coming months to change your insurance if you wish to make your coverage more appropriate for your situation.