Mississippi hospitals end Medicare Advantage agreements over declining reimbursement

Two Mississippi hospitals are ending Medicare Advantage agreements this year, announced Mike Chaney, the state's insurance commissioner.

Southwest Health System in Pike County is ending its Wellcare Medicare Advantage agreement at the end of the year, affecting 800 people. Mr. Chaney said some visits will not be considered in-network, and health plan members would see reduced benefits once the agreement ends.

"From what we understand, Wellcare has over 30,000 [Medicare] Advantage consumers in the state. They tell us that they only have 800 in Pike County and that they are working to secure several facilities that will see Wellcare patients within 10 miles of the hospital," he said.

Tupelo-based North Mississippi Health System, the parent company of North Mississippi Medical Center, also is ending its multiyear provider network agreement with Humana's Medicare Advantage plans on Dec. 31. North Mississippi Health Services notified patients of the decision earlier this month, citing frequent claim denials. Both sides started negotiations in June.

Mr. Chaney said the underlying issue with hospitals ending Medicare Advantage agreements is reimbursement.

"Health providers, whether doctors or hospitals, are demanding more payment for their services rendered to those on Medicare, and the Medicare Advantage plans are refusing to pay more," he told The Clarion-Ledger.

Mr. Chaney encouraged patients to consider other health plans but said they need to do that before the Dec. 7 Medicare open-enrollment deadline.

 

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