Wiki Doc getting squeezed out of some Medicare Plan C's

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loriroberts36

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I just started working for a surgeon who is still in private practice. He is very old school and still mostly receives paper checks unless he is forced into EFTs. He is starting to be squeezed out of some Medicare Managed care Plans. Humana Gold and UHC AARP are two examples. I am new to the industry and to his office and do not understand why this is happening. Does anyone have any thoughts as to why is may be going on?
 
You need to contact the PR rep ASAP to find out what is going on. Did you miss his recredentialling? Was there something prior to when you got the position where he may have been on probation for something? That just seems odd. You need to do some more inquiring on his behalf and yours.
 
Part C (Medicare Advantage) plans allow you to choose to receive all of your health care services through a provider organization. You must have both Parts A and B to enroll in Part C.
So is your provider solo practice? He may not have the "volume" that the C plans want...out with the old, in with the new. Look at your contracts. Any patient complaints? Your provider may not fit into the bell shape curve on usage, services, medications. Good luck.
 
He is in a solo practice. Come to find out several other physicians in private practice in the area are going through the same thing. We are trying to get a hearing scheduled soon. Will keep you posted.
 
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