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St Charles Won't Accept All Medicare Advantage

BEND, OR -- St Charles Health System will not be an in-network provider for Medicare Advantage plans offered by HealthNet, Humana, and WellCare in 2024.

The hospital has been re-evaluating its agreements with insurance providers since August. Chief financial officer Matt Swafford, recently told KBND News the goal is to reduce patient restrictions and administrative burdens, “That will promote access to care and also promote the ability to get patients into the right settings of care at the right time. And that is evidence based and clinically appropriate.”

Last week, the hospital came to agreement with Pacific Source to accept its Medicare Advantage and other plans. Swafford spoke on the challenges in negotiating the plans, which are publicly funded, but privately managed, “When you're actually embarking on something that is new and quite different from the typical conversations that you might assume go on between insurance companies and hospital systems, those are difficult, but they're difficult getting oriented around what really truly will impact patients positively.”

After the hospital worked out a deal with Pacific Source, Swafford said it will streamline processes for seniors who rely on Medicare Advantage for medical care, outpatient services, and prescriptions, “2024 will be an important test year for initially with the cancer center and looking at other areas where we can collaborate to reduce administrative burden.” Swafford had hoped the Pacific Source deal would serve as a model for other insurance companies.

St Charles chief clinical officer Dr. Mark Hallett cites restrictions on care and other hoops patients have to jump through as the reason hospitals can’t continue with the insurance status quo. “All those different steps slow down your care, and actually potentially risk financial denial of coverage on the backside,” Hallett said.

In 2024, in addition to Pacific Source, St. Charles will also accept plans from Providence, Moda, and Regence Blue Cross Blue Shield. The Medicare open enrollment begins October 15th.


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