1. St. Charles announces Medicare Advantage deal with PacificSource
2. St. Charles may drop Medicare Advantage plans, causing confusion and concern

St. Charles Health System has declined to continue as an in-network provider for Medicare Advantage Plans from Humana, HealthNet and WellCare, citing administrative burdens and concerns for patient welfare.

Starting in 2024, the health system will only accept Medicare Advantage plans from PacificSource, Providence, Moda and Regence Blue Cross Blue Shield. According to additional information published by St. Charles, only those insured by Humana, HealthNet and WellCare who are undergoing active treatment plans for cancer care, outpatient rehab, wound care and dialysis care can continue to receive services from the health system.

“We care deeply about our patients and the care they receive, which is why we are unwilling to continue with the status quo with Medicare Advantage plans that result in restrictions to patient care, longer hospital stays and administrative burdens for providers,” said Dr. Mark Hallett, chief clinical officer. “We are grateful that some insurance partners were willing to come to the table and try out innovative solutions to these complex problems.”

Last week, Hallett commended PacificSource for its willingness to negotiate with St. Charles after the pair reached an advantageous deal that would streamline patient care on Sept. 29. Specifically, the new deal allows St. Charles physicians to bypass authorization for standard-of-care procedures. It also streamlined discharge procedures, reducing the length of in-patient stays.

While Hallett said in a news release Thursday that he hopes the deal with PacificSource will “serve as a model for future discussions,” Henrick Jahn, president of Insure Bend, expressed concern after the PacificSource deal was announced last week that it could set unattainable standards for other companies. “There’s only so much money to go around,” he said.

When St. Charles announced it would reevaluate its in-network status of Medicare Advantage plans in August, The Bulletin reported that the decision created confusion and concern among patients. According to Jahn, many of his clients, especially seniors, were alarmed at the prospect they may need to reassess their insurance providers.

Medicare Advantage plans primarily cover individuals who regularly need in-hospital care, such as seniors and people with disabilities. As St. Charles is the only provider for in-hospital care in Central Oregon, those who fall under that demographic will be forced to switch coverage or travel across the Cascades to receive care.

The following are key dates those covered by Humana, HealthNet and WellCare Medicare Advantage plans should be aware of.

Oct. 15, 2023 — Medicare open enrollment opens

Dec. 7, 2023 — Medicare open enrollment closes

Dec. 31, 2023 — Coverage under Humana ends

Feb. 1, 2024 — Coverage under HealthNet and WellCare ends

For those who still have questions about St. Charles Health System and its in-network Medicare Advantage providers, the health center has published a facts and questions page with more information: https://www.stcharleshealthcare.org/patients/billing-and-insurance/medicare-advantage-faq. Or, those with questions can call 541-612-8378.

People who are still unsure of their options and coverage status are encouraged to reach out to their insurance providers directly.

Editor’s note: This article has been corrected. The original version misstated the phone number for Medicare Advantage questions. The Bulletin regrets the error.