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Southwest, LCH opt out of WellCare

Southwest Health System, which includes Southwest Mississippi Regional Medical Center, Lawrence County Hospital and its affiliated clinics and physicians, is leaving a Medicare Advantage network at the end of the year over disputes about reimbursement rates, the Enterprise-Journal reported.

That means some patients using WellCare Advantage health care plans will have to find an alternate source of coverage for their medical expenses.

King’s Daughters Medical Center, however, has no plans to opt out of the WellCare program, said hospital spokesman David Culpepper.

Southwest Health System recently sent letters to Medicare patients informing them that beginning in 2019 it will no longer participate in the WellCare Advantage health care plans.

Spokesperson Tina Brumfield said WellCare’s denial rate for coverage is about 40 percent and the hospital is being reimbursed just pennies on the dollar for the services it provides.

Disputes over reimbursements have apparently led to some patients thinking their Medicare Advantage coverage would take care of their hospital bills when in fact it hasn’t, and that has left the hospital stuck with covering expenses for services it provides, Brumfield said.

Medicare patients enrolled in a Medicare Advantage plan, which is similar to traditional health insurance, pay a premium and co-pays, and the plan administrator handles all the patient’s Medicare claims. Patients with Medicare Advantage plans must go to doctors and medical facilities that are in their provider’s network.

WellCare patients won’t be able to use services through Southwest or Lawrence County Hospital after Dec. 31.

Patients who want to search for other Medicare Advantage plans must be enrolled in Medicare — open enrollment runs through Dec. 7 — and sign up for a supplement or Medigap plan to cover co-pays, deductibles and co-insurance not covered by Medicare.

For assistance call Mississippi State Health Insurance Assistance Program at 844-822-4622.

Humana’s Medicare Advantage plan is the only one that Southwest will accept after the new year, Brumfield said. 

Patients who enroll in a Medicare Advantage plan can opt to switch back to traditional Medicare coverage and supplements from Jan. 1 through March 31, 2019.