Q&A with Dr. Tom
One of my favorite specialists is not accepting my largest Medicare Advantage plan next year? What can I do?
Too many clinicians sit passively by and let the insurers dictate specialty panel composition.
Medicare Advantage, more than any other insurance program, is a collaboration between the prime and the insurer.
If you have a favored specialist that’s dropping out, whether by choice of by force, call them and ask why.
Then call your insurer’s provider relations line and begin the discussion.
Make the case why it's everyone’s best interest to keep that specialist in the game. Have some numbers to back it up; patient satisfaction, utilization etc. But make case.
Making the case itself is more than half the battle.
Just by demonstrating passion and engagement you’ll impress your insurer—-and that alone might be enough.
Frequent causes of "specialist-drop-out" are reimbursement rate reduction and network narrowing.
Both of these are done by insurers using a broad brush.
There’s plenty of wiggle room for an exception—-particularly if it’s presented with engagement and passion.
A waste of time? Hopelessly naive?
Before my experience in Medicare Advantage, I would have agreed with you.
But I have seen the influence borne of passion and engagement with my own eyes.
Just try it.
Go to bat for your favorite specialist.
You will see the influence too.