ARCHIVE

Medicare Advantage no longer accepted at St. Luke Hospital

Plan will be accepted for emergencies

Staff reporter

St. Luke Hospital will no longer accept Medicare Advantage, the part C of the Medicare program.

The board of directors of Marion County Hospital District #1 decided April 24 to discontinue the acceptance of the commercial card.

Hilary Dolbee, chief financial officer of the hospital, explained to the board that the hospital has tried to work with the providers, primarily Humana Gold, in settling accounts but has been unsuccessful.

Since St. Luke Hospital is a critical access facility, the billing process is different with the Medicare Advantage providers. Dolbee said no other critical access hospitals, that she is aware of, are accepting Medicare Advantage for the same reason.

Last year there were $22,000 in claims, Dolbee said, from a total of 10 patients. Those with Medicare Advantage plans can be treated at the hospital but will be billed directly. The patient then will be responsible for being reimbursed from the insurance company.

Medicare Advantage is a commercial-based health insurance that is not the federally-funded Medicare insurance coverage. Several independent carriers offer Medicare Advantage which takes the place of the other Medicare coverage.

Dolbee said part of the confusion also was in differentiating between traditional Medicare and Medicare Advantage.

An advertisement will be in the hospital's official newspaper, the Marion County Record, and letters will be sent to patients who have used Medicare Advantage in the past to inform them of the change.

Board chairman Judy Reno said she is aware of some patients who are concerned that the hospital can no longer accept Medicare Advantage but added that the board needed to stand behind Dolbee.

The board agreed.

Dolbee will continue to work with the insurance providers in settling this matter so the insurance can be accepted in the future.

Quantcast