Doctors Losing Patients to Medicare Advantage

Question: Why are physicians losing patients to Medicare Advantage when patients turn 65?
Answer: A policy known as seamless conversion allows insurance companies to move members of their commercial or Medicaid managed-care plans over to Medicare Advantage plans if they first ask permission from the CMS. The Medicare Advantage plans mean more revenue for insurers, but it often means patients’ doctors will be considered out of network. The CMS believes the transition to Medicare Advantage should be implemented to ensure continuity of care and recently issued a memo to insurers reminding them about seamless conversion as a way to transition enrollees. In a letter to the CMS, the Medical Society of New Jersey called out the agency noting that “seamless conversion merely insures that carriers keep their member base: it does not facilitate continuity of care; it does not facilitate the patient-physician relationship.” The concern among many healthcare providers is that the CMS’ seamless conversion is not as advantageous to patients as it is to its insurers and financial interests. Physicians nationwide have been critical of the secrecy of the plan as well and some groups are pushing for the CMS to publicly release information on which Medicare Advantage plans have been approved. The goal of assuring a continuity of care seems contradicted when a patient’s non-Medicare insurance has been covering their care at a practice but the practice is not in the Medicare Advantage plan’s network. It has been rumored that Aetna, Humana and UnitedHealthcare have asked for permission to participate in seamless conversion. Patient advocacy groups are also pushing against this policy and requesting that the CMS require insurers to get confirmation from a beneficiary that they understand their network may have changed and allow for a special enrollment period in case their doctors are not in network.

In response to the criticism, the CMS countered that beneficiaries should be more vigilant in opening and reviewing all mail from their current insurer. The CMS further shifted the onus on enrollees to make sure to ask about provider and pharmacy networks and noted that patients can opt out of Medicare Advantage plans. The CMS has also said that it will make public which insurers use seamless conversion later this year.

Weekly Charting Tip:

It is not enough to actually go through the process of patient consent to a treatment. Protect yourself and have your patient sign a consent form. Please make sure that the form is signed and dated. Additionally, if you show a video or a chart to explain a treatment, have your patient sign a document that states that they saw/reviewed the presentation on whatever date in your office (if that is the case). In other words, document, document, document!


Until next time!  - Larry Kobak, Esq.

If you have any questions, please contact us at 1-800-445-0954 or via email at


We wanted to bring you a step closer to total legal coverage. We thought you deserved more. Email us at for more details.
At Kern Augustine, P.C., we have been opposing the harassment of physicians for over thirty years. Day-in and day-out our team of highly skilled, nationally recognized attorneys battles federal and state regulators and third party payors who seek to punish, harass, investigate and/or prosecute physicians. We remain on the cutting edge of ever changing rules and regulations affecting health care practitioners and the intricacies of today’s health law.
Put Kern Augustine, P.C. on your side with the Physician Advocacy Program®

Kern Augustine, P.C., Attorneys to Health Professionals,, is solely devoted to the representation of physicians and other health care professionals.