American Society of Plastic Surgeons
For Consumers

Legislation Introduced to Protect Physicians and Patients in Medicare Advantage

Representative Rosa DeLauro (D-CT) and Senator Sherrod Brown (D-OH) have introduced the Medicare Advantage Participant Bill of Rights Act, aimed at protecting physicians and patients in Medicare Advantage (MA) from narrowing networks.

Recently, some insurance providers offering MA plans have been dropping physicians from plan networks, often without notice to the physician or to the patients they have been treating, after the open enrollment period. Since physicians are dropped after open enrollment, patients may lose access to their preferred provider during the course of treatment.

This legislation would prevent MA plans from dropping physicians from the network in the middle of a plan year without cause, with cost of the physician to the plan explicitly stated as not being a reasonable cause for removal.

The bill would also require the MA plan to notify physicians and the patients they treat that the physician is removed from the plan network at least 60 days prior to open enrollment and would require the plan to notify the physician as to why they are being dropped. Notification to patients would also need to include information on other providers of similar services, information on how to request continuation of medical treatment with the same physician and at least one customer service telephone number.

ASPS will monitor this legislation as it moves forward.