Signaling what may be an emerging national trend, two influential medical groups with San Diego-based Scripps Health are cancelling their Medicare Advantage contracts for 2024 because of low reimbursement and prior authorization hassles, leaving 30,000 enrolled seniors to look for new doctors, or different coverage.

“Negotiations with the payers for MA with our medical foundation groups and Scripps Health were unsuccessful and we have been forced to withdraw from those plans due to annual losses that exceeded $75 million,” Scripps CEO Chris Van Gorder told MedPage Today in an early morning email.

He said the losses are due to “low reimbursement, denials, and administrative costs to manage high utilization and out of network care.”

Van Gorder emphasized that about 30,000 enrollees will have to make a change in their coverage or pick another doctor. About 1,000 physicians and advanced practitioners such as physician assistants are members of the two groups.

  • Uprise42@artemis.camp
    8·
    9 months ago

    These companies are scum. I worked in a call center that contracted to together health. That’s the company that used Joe Nameth in their commercials. I hadn’t sold insurance before so I went through all the training and they paid to get me certified to sell in 15 states.

    Hit the phones and I just couldn’t sell for shit. None of us could. The whole Medicare thing in general is confusing as fuck and these seniors aren’t exactly all there in the head.

    They brought in the CEO. Idk if he actually was the CEO but they claimed he was. He gave us all a “prep talk” that amounted to “say whatever you can to get the sale and let our lawyers work out the legality later down the road”

    He wanted us to get people in strictly worse plans and find new doctors and everything for a quick buck. He was fully Willing to fuck elderly people for a paycheck. I didn’t listen. Tried selling by the book but I was always at the bottom of the barrel so I was trimmed off pretty quick and let go for “poor performance”. You wanna know who was getting all the sales? The fucking drug addict who OD’d in the middle of a sale on my last day and was carted out on a gurney. The same guy who was so clueless the day prior that he tried selling a health plan for a different company and had the gall to ask if he could sell it to them anyways.

    If you want a Medicare advantage plan (which some have some really good benefits if you get the right company) you can call the phone number on the back of your Medicare card and go over plans with them. They are only there to provide information, not sell. While they can enroll you, they do not make more to enroll you or if you hang up. They do not get commission from any health insurer or anything. It is a government office with a database with every health plan offered and they simply put in your location, doctors, meds and ask some basic questions. Then they give you options for Whats available and answer your questions.