Thursday, August 7, 2014

Illinois' new Medicare-Medicaid narrow networks: the older you get, the less care you get?

In Illinois elderly patients on both Medicare and Medicaid are being forced into narrow networks under one insurance company (e.g., Aetna, Blue Cross, Cigna, Humana, Ilinicare, Meridian).

They may be lucky enough to keep their personal care provider -- but he or she is stuck referring them to specialists on the network. PCPs usually refer patients to a physically contiguous medical group: in the same hospital or office building. What happens if PCPs are forced to refer the elderly (the sick elderly) to addresses all over town?

Old people see a lot of specialists. The older -- and more infirm; the more unable to shuffle all over town by themselves -- the more specialists they need to see.  Some of the medical deflation we are going to see here may not be a healthy trend at all.

Horror of horrors: If you got to a doctor or get testing off network -- from providers that accept Medicare -- your Medicare wont pay for it?  Payment is limited to network only -- I think.

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