HARTFORD, CT — Enrollment in Medicare Advantage plans starts on Oct. 15 and all but one of Connecticut’s Congressional delegation is worried about Anthem’s decision to terminate some doctors from their network.
U.S. Sen. Richard Blumenthal, along with U.S. Reps. Rosa DeLauro, John Larson, Joe Courtney, Jim Himes, and Jahana Hayes wrote Anthem Blue Cross and Blue Shield President Jill Hummel and asked for more information about how many providers have been terminated from the network and why these providers were chosen.
The letter piggybacks on one written earlier in September by the Connecticut State Medical Society.
“By law, Medicare Advantage organizations are required to maintain and monitor a network of appropriate providers that is sufficient to provide adequate access to covered benefits and services to meet the needs of the population served,” the members wrote. “Anthem’s decision to terminate Connecticut physicians from its network will leave an insufficient network that will not provide adequate access to care for many in our state, particularly for certain specialties in medically underserved areas of the state.”
Without knowing exactly how many medical providers have been terminated because Anthem has refused to share that information, Congressional lawmakers concluded that “the network terminations will put far too many vulnerable beneficiaries at risk of failing to receive the care they need to maintain their health and prevent medical emergencies.”
But Anthem said only specialty providers in their Medicare Advantage HMO Select Plan network will be impacted.
In a statement, Anthem said it “recently notified some specialty care providers that they will not be in our Medicare Advantage HMO Select Plan network, effective January 1, 2020. Their status in Anthem’s other HMO Medicare Advantage networks will not change.”
The health insurance company said that “Anthem’s other HMO plans are available to Medicare-eligible residents in Connecticut and have a larger provider network than the Select plans. We also notified any consumers in our Select plans who have seen these providers in the last six months about this change. We think it’s important that consumers are aware of this change so they can make informed decisions when considering Anthem’s 2020 Medicare Advantage plans.”
The company maintained that it will have an adequate network of doctors for 2020.
Medicare Advantage plans are plans offered by private companies, but paid for by Medicare.
In the HMO plan, like the one the Anthem plans on changing, patients can only go to a doctor or hospital in the network and need referrals for other situations, except emergencies.
Connecticut’s delegation asked for Anthem to give them a response to their questions no later than Oct. 11, “so that we can serve our constituents and address any outstanding concerns that are brought to our attention in a reasonable amount of time.”
