Private Payer Issues
The AAFP Private Sector Advocacy team represents family physicians’ interests to non-governmental agencies. We negotiate with insurance companies, employers, health plans, and more to help you get better work conditions.
We’re working to save you time and money with:
- Better payment
- Fairer contracts
- Less administrative hassle
Information about Medicare Advantage Plans
Medicare.gov has general information(www.medicare.gov) on the Medicare Advantage (MA) program, along with related resources on coverage options in MA plans.
On average, Medicare beneficiaries will be able to choose among 19 MA plans in 2016; the total number of MA plans will reach 2001 in 2016. The premiums and out-of-pocket costs paid by enrollees vary by plan type, locale, and characteristics, such as relative breadth of the provider network and/or benefits.
Medicare beneficiaries will need to understand their MA plan choices and carefully select the plan that fits their needs.
Treatment for Chronic Hepatitis C Should be Based on the Prescribing Physician's Expertise
The AAFP has sent letters to Aetna, Anthem, Cigna, Health Care Services Corporation (HCSC), Humana, and United Healthcare (see example below), expressing the belief that treatment for chronic Hepatitis C virus (HCV) should be based on the prescribing physician's expertise rather than a requirement for medical consultation.
The AAFP opposes actions by public and private payers that limit patient access to HCV treatment pharmaceuticals prescribed by a physician using appropriate clinical training and knowledge. Also opposed are any actions that may have the effect of limiting by specialty the use of HCV pharmaceutical products. The AAFP asks payers ensure none of their insurance policies discriminate against physicians treating their patients with HCV.
Joint Letter to Commercial Carriers Concerning Adolescent Confidentiality
The AAFP has signed a joint letter to commercial carriers, Aetna, Anthem, Cigna, Health Care Services Corporation (HCSC), Humana, and United Healthcare (United). As an example, the letter to United is below.
AAFP Letter to the FTC Opposing the Merger of National Insurers
In response to the potential merger of national health insurers, the AAFP has sent a letter to the Federal Trade Commission urging the evaluation of consolidations that would limit consumer choice and decrease competition within the health insurance marketplace.
Joint Letter of Organizational Support for Model Legislation on Network Adequacy
The AAFP has signed a joint letter to state policymakers in support of model legislation that would serve as a template for revising state network adequacy standards, as it relates to narrow/high-value networks.
The AAFP is working to establish reasonable and meaningful standards for network adequacy, while still allowing for market flexibility and choice.
AAFP's Response to UnitedHealthcare's Narrowing Networks
The AAFP has sent letters to UnitedHealthcare (UHC), America's Health Insurance Plans (AHIP), and the Centers for Medicare & Medicaid Services (CMS).
These letters collectively voice concerns regarding United’s one-sided actions that disrupt patient-physician relationships and dictate to patients which doctor they are allowed to see with little to no input from the patients themselves.
The letters end with the desire to set up an ongoing dialogue to better understand the current state, determination, and effects of narrow or high-value networks.
AAFP's Response to UnitedHealthcare's in Home Visits
The AAFP has sent a letter to UnitedHealthcare (UHC) raising concerns related to UHC's sending out nursing services to conduct Annual Wellness Visits on Medicare Advantage (MA) beneficiaries in their homes and how this further fragments care that the family physician provides.
- Verifying Coverage Key for Patients Insured Via Marketplace from the AAFP Leader Voices blog
- Member Feedback Drives AAFP Advocacy on Narrow Networks from AAFP News