{"id":11469,"date":"2025-08-29T16:22:31","date_gmt":"2025-08-29T16:22:31","guid":{"rendered":"https:\/\/midamerica.news\/wright-county-monitor\/?p=11469"},"modified":"2025-09-03T16:07:41","modified_gmt":"2025-09-03T16:07:41","slug":"iowa-specialty-hospital-to-stop-accepting-certain-medicare-advantage-plans","status":"publish","type":"post","link":"https:\/\/midamerica.news\/wright-county-monitor\/2025\/08\/29\/iowa-specialty-hospital-to-stop-accepting-certain-medicare-advantage-plans\/","title":{"rendered":"Iowa Specialty Hospital to Stop Accepting Certain Medicare Advantage Plans"},"content":{"rendered":"<p class=\"zw-paragraph heading0\" data-linerule=\"auto\" data-line-height=\"1.2\" data-header=\"0\" data-textformat=\"{&quot;fgc&quot;:&quot;rgb(0, 0, 0)&quot;,&quot;size&quot;:&quot;12.00&quot;,&quot;type&quot;:&quot;text&quot;}\" data-margin-left=\"0.0in\" data-text-indent=\"0.5in\" data-margin-bottom=\"0.0pt\" data-margin-top=\"8.0pt\" data-hd-info=\"0\" data-keep-line-info=\"false\" data-page-break-info=\"false\" data-window-control-info=\"false\" data-keep-next-info=\"false\"><em>by Amanda Rink, Editor<\/em><\/p>\n<p class=\"zw-paragraph heading0\" data-linerule=\"auto\" data-line-height=\"1.2\" data-header=\"0\" data-textformat=\"{&quot;fgc&quot;:&quot;rgb(0, 0, 0)&quot;,&quot;size&quot;:&quot;12.00&quot;,&quot;type&quot;:&quot;text&quot;}\" data-margin-left=\"0.0in\" data-text-indent=\"0.5in\" data-margin-bottom=\"0.0pt\" data-margin-top=\"8.0pt\" data-hd-info=\"0\" data-keep-line-info=\"false\" data-page-break-info=\"false\" data-window-control-info=\"false\" data-keep-next-info=\"false\">Iowa Specialty Hospitals and Clinics will no longer accept certain Medicare Advantage plans. This is a move hospital leaders say is meant to protect patients and staff from a system that often delays or denies needed care.<\/p>\n<p class=\"zw-paragraph heading0\" data-linerule=\"auto\" data-line-height=\"1.2\" data-header=\"0\" data-textformat=\"{&quot;fgc&quot;:&quot;rgb(0, 0, 0)&quot;,&quot;size&quot;:&quot;12.00&quot;,&quot;type&quot;:&quot;text&quot;}\" data-margin-left=\"0.0in\" data-text-indent=\"0.5in\" data-margin-bottom=\"0.0pt\" data-margin-top=\"8.0pt\" data-hd-info=\"0\" data-keep-line-info=\"false\" data-page-break-info=\"false\" data-window-control-info=\"false\" data-keep-next-info=\"false\">Medicare is the federal health insurance program for people 65 and older. Medicare Advantage plans are run by private insurance companies. Funded with federal dollars, they must cover the same basic services as Medicare, but hospital leaders say they frequently add hurdles such as prior authorizations, narrow provider networks, and slow reimbursements.<\/p>\n<p class=\"zw-paragraph heading0\" data-linerule=\"auto\" data-line-height=\"1.2\" data-header=\"0\" data-textformat=\"{&quot;fgc&quot;:&quot;rgb(0, 0, 0)&quot;,&quot;size&quot;:&quot;12.00&quot;,&quot;type&quot;:&quot;text&quot;}\" data-margin-left=\"0.0in\" data-text-indent=\"0.5in\" data-margin-bottom=\"0.0pt\" data-margin-top=\"8.0pt\" data-hd-info=\"0\" data-keep-line-info=\"false\" data-page-break-info=\"false\" data-window-control-info=\"false\" data-keep-next-info=\"false\">The difference often becomes clear inside the hospital. \u201cWhen we have patients on Medicare Advantage plans, many of the plans require pre-authorization for services,\u201d said Chief Nursing Officer Beth Carder. She noted multiple cases where doctors and nurses recommended continued care but insurers determined there was not medical necessity for the services. \u201cFamilies are confused and frustrated because their patient isn\u2019t authorized for those services. Some have ended up paying privately, which can get pricey as well.\u201d<\/p>\n<p class=\"zw-paragraph heading0\" data-linerule=\"auto\" data-line-height=\"1.2\" data-header=\"0\" data-textformat=\"{&quot;fgc&quot;:&quot;rgb(0, 0, 0)&quot;,&quot;size&quot;:&quot;12.00&quot;,&quot;type&quot;:&quot;text&quot;}\" data-margin-left=\"0.0in\" data-text-indent=\"0.5in\" data-margin-bottom=\"0.0pt\" data-margin-top=\"8.0pt\" data-hd-info=\"0\" data-keep-line-info=\"false\" data-page-break-info=\"false\" data-window-control-info=\"false\" data-keep-next-info=\"false\">Chief Compliance Officer Reagan Swisher said many patients don\u2019t realize how different Medicare Advantage is from traditional Medicare. \u201cMany families think that when they have Medicare Advantage&#8230; it\u2019s Medicare, because of that Medicare Advantage name,\u201d he said. \u201cHealth insurance is difficult to understand on a good day.\u201d<\/p>\n<p class=\"zw-paragraph heading0\" data-linerule=\"auto\" data-line-height=\"1.2\" data-header=\"0\" data-textformat=\"{&quot;fgc&quot;:&quot;rgb(0, 0, 0)&quot;,&quot;size&quot;:&quot;12.00&quot;,&quot;type&quot;:&quot;text&quot;}\" data-margin-left=\"0.0in\" data-text-indent=\"0.5in\" data-margin-bottom=\"0.0pt\" data-margin-top=\"8.0pt\" data-hd-info=\"0\" data-keep-line-info=\"false\" data-page-break-info=\"false\" data-window-control-info=\"false\" data-keep-next-info=\"false\">Iowa Specialty CEO Steve Simonin said the hospital is preparing to notify patients about which plans will no longer be accepted, some Advantage plans will still be accepted. \u201cWe are planning on sending a letter via MyChart to all of our patients discussing which Medicare Advantage plans we don\u2019t accept,\u201d he told The Wright County Monitor.<\/p>\n<p class=\"zw-paragraph heading0\" data-linerule=\"auto\" data-line-height=\"1.2\" data-header=\"0\" data-textformat=\"{&quot;fgc&quot;:&quot;rgb(0, 0, 0)&quot;,&quot;size&quot;:&quot;12.00&quot;,&quot;type&quot;:&quot;text&quot;}\" data-margin-left=\"0.0in\" data-text-indent=\"0.5in\" data-margin-bottom=\"0.0pt\" data-margin-top=\"8.0pt\" data-hd-info=\"0\" data-keep-line-info=\"false\" data-page-break-info=\"false\" data-window-control-info=\"false\" data-keep-next-info=\"false\">Hospitals nationwide are making similar moves. At least 27 health systems have stopped accepting certain Medicare Advantage plans, citing excessive prior authorization denials and slow insurer payments. On average, the federal government pays insurers about $1,000 a month for each enrollee, but hospitals say that hasn\u2019t always translated into reliable coverage for patients.<\/p>\n<p class=\"zw-paragraph heading0\" data-linerule=\"auto\" data-line-height=\"1.2\" data-header=\"0\" data-textformat=\"{&quot;fgc&quot;:&quot;rgb(0, 0, 0)&quot;,&quot;size&quot;:&quot;12.00&quot;,&quot;type&quot;:&quot;text&quot;}\" data-margin-left=\"0.0in\" data-text-indent=\"0.5in\" data-margin-bottom=\"0.0pt\" data-margin-top=\"8.0pt\" data-hd-info=\"0\" data-keep-line-info=\"false\" data-page-break-info=\"false\" data-window-control-info=\"false\" data-keep-next-info=\"false\">To help patients sort through their options, leaders point to SHIIP, the Senior Health Insurance Information Program, a free, confidential service run by the Iowa Insurance Division. SHIIP volunteers are available in Belmond, Clarion, Hampton, and Garner to help seniors compare plans before they enroll.<\/p>\n<p class=\"zw-paragraph heading0\" data-linerule=\"auto\" data-line-height=\"1.2\" data-header=\"0\" data-textformat=\"{&quot;fgc&quot;:&quot;rgb(0, 0, 0)&quot;,&quot;size&quot;:&quot;12.00&quot;,&quot;type&quot;:&quot;text&quot;}\" data-margin-left=\"0.0in\" data-text-indent=\"0.5in\" data-margin-bottom=\"0.0pt\" data-margin-top=\"8.0pt\" data-hd-info=\"0\" data-keep-line-info=\"false\" data-page-break-info=\"false\" data-window-control-info=\"false\" data-keep-next-info=\"false\">Medicare\u2019s open enrollment period runs from September through December. Iowa Specialty leaders say they hope residents take time to review their choices carefully.<\/p>\n<p class=\"zw-paragraph heading0\" data-linerule=\"auto\" data-line-height=\"1.2\" data-header=\"0\" data-textformat=\"{&quot;fgc&quot;:&quot;rgb(0, 0, 0)&quot;,&quot;size&quot;:&quot;12.00&quot;,&quot;type&quot;:&quot;text&quot;}\" data-margin-left=\"0.0in\" data-text-indent=\"0.5in\" data-margin-bottom=\"0.0pt\" data-margin-top=\"8.0pt\" data-hd-info=\"0\" data-keep-line-info=\"false\" data-page-break-info=\"false\" data-window-control-info=\"false\" data-keep-next-info=\"false\">\u201cThis isn\u2019t about making life harder on patients,\u201d Simonin said. Ultimately, the hospital system wants patients to understand the coverage they are signing up for. \u201cThey\u2019re our neighbors,\u201d Simonin stated. In Iowa, we take care of our neighbors.<\/p>\n<p data-linerule=\"auto\" data-line-height=\"1.2\" data-header=\"0\" data-textformat=\"{&quot;fgc&quot;:&quot;rgb(0, 0, 0)&quot;,&quot;size&quot;:&quot;12.00&quot;,&quot;type&quot;:&quot;text&quot;}\" data-margin-left=\"0.0in\" data-text-indent=\"0.5in\" data-margin-bottom=\"0.0pt\" data-margin-top=\"8.0pt\" data-hd-info=\"0\" data-keep-line-info=\"false\" data-page-break-info=\"false\" data-window-control-info=\"false\" data-keep-next-info=\"false\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-11495 aligncenter\" src=\"https:\/\/midamerica.news\/wright-county-monitor\/wp-content\/uploads\/sites\/22\/2025\/08\/Screen-Shot-2025-09-03-at-11.01.58-AM-1024x909.jpg\" alt=\"\" width=\"640\" height=\"568\" srcset=\"https:\/\/midamerica.news\/wright-county-monitor\/wp-content\/uploads\/sites\/22\/2025\/08\/Screen-Shot-2025-09-03-at-11.01.58-AM-1024x909.jpg 1024w, https:\/\/midamerica.news\/wright-county-monitor\/wp-content\/uploads\/sites\/22\/2025\/08\/Screen-Shot-2025-09-03-at-11.01.58-AM-300x266.jpg 300w, https:\/\/midamerica.news\/wright-county-monitor\/wp-content\/uploads\/sites\/22\/2025\/08\/Screen-Shot-2025-09-03-at-11.01.58-AM-768x682.jpg 768w, https:\/\/midamerica.news\/wright-county-monitor\/wp-content\/uploads\/sites\/22\/2025\/08\/Screen-Shot-2025-09-03-at-11.01.58-AM-1170x1038.jpg 1170w, https:\/\/midamerica.news\/wright-county-monitor\/wp-content\/uploads\/sites\/22\/2025\/08\/Screen-Shot-2025-09-03-at-11.01.58-AM-600x532.jpg 600w, https:\/\/midamerica.news\/wright-county-monitor\/wp-content\/uploads\/sites\/22\/2025\/08\/Screen-Shot-2025-09-03-at-11.01.58-AM.jpg 1466w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><\/p>\n","protected":false},"excerpt":{"rendered":"<p>by Amanda Rink, Editor Iowa Specialty Hospitals and Clinics will no longer accept certain Medicare Advantage plans. This is a move hospital leaders say is meant to protect patients and staff from a system that often delays or denies needed care. Medicare is the federal health insurance program for people<\/p>\n","protected":false},"author":18183,"featured_media":11470,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4091],"tags":[],"class_list":["post-11469","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-local-news",""],"nelio_content":{"autoShareEndMode":"never","automationSources":{"useCustomSentences":false,"customSentences":[]},"efiAlt":"","efiUrl":"","followers":[18183],"highlights":[],"isAutoShareEnabled":true,"networkImageIds":[],"permalinkQueryArgs":[],"series":[],"suggestedReferences":[]},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Iowa Specialty Hospital to Stop Accepting Certain Medicare Advantage Plans - The Wright County Monitor<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/midamerica.news\/wright-county-monitor\/2025\/08\/29\/iowa-specialty-hospital-to-stop-accepting-certain-medicare-advantage-plans\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Iowa Specialty Hospital to Stop Accepting Certain Medicare Advantage Plans - The Wright County Monitor\" \/>\n<meta property=\"og:description\" content=\"by Amanda Rink, Editor Iowa Specialty Hospitals and Clinics will no longer accept certain Medicare Advantage plans. This is a move hospital leaders say is meant to protect patients and staff from a system that often delays or denies needed care. 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