Southwest Medical reverses decision on traditional Medicare patients

Updated September 21, 2017 - 7:04 pm

Southwest Medical Associates said Thursday it is reversing its decision to stop providing care next year to about 7,000 Southern Nevada seniors with traditional Medicare plans.

In a statement to the Review-Journal, which first reported the health care provider’s plan two weeks ago, Southwest Medical said it was reversing course after receiving complaints from patients who said they would be forced to find new doctors.

“After listening to our patients, Southwest Medical will continue providing care to our current Original Medicare patients, and we are reaching out to them to make sure they know this,” it said.

Greg Griffin, chief operating officer of Southwest, declined to say how many angry consumers contacted Southwest.

While the company will continue to offer coverage to its current patients with traditional or original Medicare plans, it said that it will not offer those plans to new customers in Southern Nevada as of Jan. 1.

Southwest Medical, one of only two major health care providers in Southern Nevada offering traditional Medicare coverage, will continue to offer Medicare Advantage plans from private insurance plans, which can be more costly.

‘That’s fair’

The company’s reversal satisfied 66-year-old Anne Zarate, who had complained that the timing of the company’s decision to abandon the traditional Medicare market appeared to be an effort to upsell patients to Medicare Advantage plans.

“I think that’s fair,” she said Thursday. “That’s new business for them, and they can do what they want with that.”

She also wondered if Southwest was concerned about losing many of its traditional Medicare patients to rival HealthCare Partners of Nevada. Officials with Heathcare Partners told the Review Journal this week they gladly would accommodate all of Southwest’s patients.

Southwest had no comment.

Griffin, the Southwest COO, declined to say why patients said they wanted to stay on traditional fee-for-service Medicare plans when Southwest offers Health Maintenance Organization Medicare Advantage plans that do not cost patients an extra premium and offer zero dollar co-pays and deductibles and vision and dental benefits.

But David Karel, a Las Vegas insurance broker specializing in Medicare plans, said flexibility is generally a big reason cited by patients.

Traditional Medicare patients can go to any doctor or specialist that accepts Medicare, while patients on a private HMO Medicare Advantage plan generally can use only in-network providers and must get a referral to see a specialist. And if you go outside the plan, you might be required to pay for all or most of the services, he added.

Zarate prefers the flexibility that allows her to pick any physician she wants. She bought a Medigap policy that covers the portion of health care costs that traditional Medicare doesn’t pick up — generally about 20 percent.

So if she wants to see a specialist in California or Texas for a health problem, she can do so without worrying about the cost.

More flexibility, more dollars

Providers offer Advantage plans known as Preferred Provider Organization plans that provide more flexibility, but those can cost between $49 and $129 more a month, Karel said.

Those plans don’t require a referral to see a specialist or allow a patient to see out-of-network providers, but the patient might have to pay more for a visit.

Those plans still don’t provide as much flexibility as original Medicare with a Medigap supplement, he said.

Southwest, an affiliate of UnitedHealth Group’s Optum Care unit, will continue to offer two UnitedHealthcare Medicare Advantage plans to new patients in Southern Nevada.

According to Karel, what helps make Advantage plans so profitable is that the government pays insurers a predetermined amount for an Advantage patient, regardless of what treatment they receive. With their provider networks, which give them leverage to bargain for favorable rates from medical practitioners and facilities, that helps them reduce costs and increase profits, he said.

UnitedHealth Group is defending itself against a lawsuit filed in May by the U.S. Justice Department over its Medicare Advantage plans.

That lawsuit alleges that UnitedHealth made patients appear sicker on paper than they really were —“upcoding” — to bilk the government out of billions, $3 billion from 2010 to 2015 alone.

With Medicare Advantage patients,the government pays insurers a predetermined amount for each person enrolled based on insurer-supplied “risk scores,” rather than than paying fees for service, as is done for traditional Medicare.

A UnitedHealth spokesman said the lawsuit is without merit.

Contact Paul Harasim at pharasim@reviewjournal.com or 702 387-5273. Follow @paulharasim on Twitter.

ad-high_impact_4
News
Bicyclist suffers major head trauma in hit-and-run
A bicyclist was hospitalized with life-threatening injuries after a Thursday morning hit-and-run crash near the school formerly known as Agassi Prep. Police said the bicyclist was hit by a white SUV, which fled the scene. The injured man suffered multiple injuries including major head trauma. As of 9 a.m., Lake Mead remained closed between Martin Luther King and Revere Street while police investigate.
Las Vegas artist Dave Dave dies at 42
Dave Dave talks about his art and his life in 2016. (Michael Quine/Las Vegas Review-Journal)
Dave Dave, whose dad set him on fire in 1983, dies
Dave Dave, a respected Las Vegas artist who was badly scarred as a boy when his father tried to burn him to death in Southern California, died at Sunrise Hospital on July 15. He was 42. When he was 6, Dave's father tried to kill him by setting him on fire. He was given a sleeping pill and his bed at a Buena Park, California, motel was doused with kerosene. “I remembered being in a lot of pain,” Dave told the Review-Journal in 2016. “When stuff happens to you at that young of an age, you tend to block it out, but I remember the pain was excruciating.” Dave, who was born David Rothenberg, became close friends with Michael Jackson, who met him after the attack, which burned more than 90 percent of his body. “I wanted to meet him, and he wanted to meet me, and that just turned into a lifelong relationship that never ended,” Dave said. “It was amazing being friends with Michael Jackson. He was an amazing person.” Dave attended ArtCenter College of Design in Pasadena, California, and collaborated with various artists around Las Vegas, eventually selling his art to private collectors. Despite his challenges, he continued to live, thrive and create. Dave Dave
Homicide detectives investigate woman's death
Las Vegas police were called to Tahiti Village Resort early Wednesday after calls that someone had been shot. Police found a woman’s body between a parking garage and boiler room on the resort's property. A guest first reported hearing gunfire. There are no witnesses, but police will examine surveillance videos and look for clues. The woman was not identified, but a purse was found near the body. She did not appear to be a guest at the resort.
LVMPD Discusses Ross Dress for Less Shooting
LVMPD Assistant Sheriff Charles Hank discussed the 15th officer-involved shooting of the year at a press conference at Metro headquarters on Tuesday, Aug. 14. The active-shooter incident took place at the Ross Dress for Less store at the 4000 block Blue Diamond Road in the south Las Vegas Valley. (Madelyn Reese/ Las Vegas Review-Journal)
Metro Asst. Sheriff Brett Zimmerman on Aug. 8 officer-involved shooting
Metropolitan Police Department Assistant Sheriff Brett Zimmerman met with media Monday to discuss the details of the 14th officer-involved shooting of the year. (Madelyn Reese/ Las Vegas Review-Journal)
Clark County School Board president Deanna Wright on travel expenses
Clark County School Board President Deanna Wright says she followed proper expense protocol in trip to Florida last year.
Matt Kelly Elementary School hosted its third annual Back-to-School Red Carpet Program
Matt Kelly Elementary School hosted its third annual Back-to-School Red Carpet Program where community and business leaders joined to welcome students back with an inspirational welcome. Bizuayehu Tesfaye/Las Vegas Review-Journal @bizutesfaye
Shooting leaves 1 dead in southeast valley
A man was found fatally shot in the doorway of a squatter apartment after an argument ended in gunfire on Sunday night. Officers responded about 10:30 p.m. to the Silver Pines apartments and discovered the man in a breezeway in one of the buildings. The wounded man died at the scene, despite the efforts of another person, who tried to administer medical aid. Witnesses saw a man and a woman flee the scene, but were unable to give police a clear description.
North Las Vegas unveils new school crosswalk
North Las Vegas councilman Isaac Barron talks about the new school crosswalk in front of CP Squires Elementary School Monday, August 6, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
LVMPD Briefing on OIS #13
Assistant Sheriff Tim Kelly held a press conference to discuss details of the 13th officer-involved-shoot for the department in 2018. Video shows the moments before the suspect was shot. The shooting, which has been edited out, occurred as the suspect lunged at an officer outside the apartment. (Madelyn Reese/Las Vegas Review-Journal)
Sedan and semitrailer collide in south Las Vegas
An early Wednesday morning crash has left one person in critical condition. A sedan and semitrailer collided around 4 a.m. at the corner of Spencer Street and Serene Avenue. Police do not believe impairment is a factor in the crash. Spencer has been blocked off north of Serene while police continue their investigation.
Cybersecurity Professionals Flock to Las Vegas for Black Hat
Black Hat USA, the largest annual cybersecurity conference, is expecting a record 17,000 attendees during its six-day run at the Mandalay Bay Convention Center this week. One thing attendees have in mind is making sure they don't get hacked while they're there. (Madelyn Reese/Las Vegas Review-Journal)
Police chase ends with suspects captured in east Las Vegas
An early Tuesday morning chase ended with a car crash in an east Las Vegas neighborhood. Police were pursuing the vehicle, which they say was involved in robberies in Las Vegas and North Las Vegas, when the driver crashed at Owens and Statz Street. A man was taken into custody. A woman was ejected from a vehicle and taken to a hospital with non-life threatening injuries. The intersection at Mojave Road and Owens Avenue was shut down while police officers searched for the suspect and investigated. The intersection will remain closed for most of the morning.
Record number participate in Touro University Nevada White Coat Ceremony
Three hundred sixty-five medical students received their white coats during the Touro University Nevada White Coat Ceremony at the M Resort in Henderson Monday. The ceremony was developed to honor students in osteopathic medicine, physician assistant studies, nursing, occupational therapy and physical therapy as they accept the professional responsibilities inherent in their relationship with patients. (K.M. Cannon/Las Vegas Review-Journal)
Stop for school buses, urges CCSD
Clark County School District Police Department hold a mock traffic stop at Centennial High School in Las Vegas, Monday, Aug. 6, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Work Begins at Las Vegas Community Healing Garden
Crews moved the wooden Remembrance Wall at the Las Vegas Community Healing Garden on South Casino Center Boulevard Monday. Construction on a permanent wall is set to begin within the week. (Madelyn Reese/Las Vegas Review-Journal) @MadelynGReese
Man wounded outside Cottages apartment
Las Vegas police don't have a motive after a man was shot early Monday morning outside a northwest valley apartment. The man's mother called police to say her son had been shot. She called police around 1:15 a.m. Other people were inside the apartment but no one else was injured. Police are still looking for the shooter.
Ride new Interstate 11 segment in one minute
Interstate 11 opens to the public Thursday, providing sweeping views of Lake Mead, art deco-style bridges and a mural illustrating the construction of Hoover Dam. (K.M. Cannon/Las Vegas Review-Journal)
Miss El Tiempo 2019
Miss Teen El Tiempo and Miss El Tiempo 2019 were crowned at Sam's Town Saturday, August 4, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Las Vegas Woman Raises Awareness for Anxiety and Depression
Cassi Davis was diagnosed with anxiety and depression after the birth of her second child. After seeking help and support, she felt that there wasn't enough for support for those living day in and day out for those with mood disorders. She created the Crush Run, set for Sept. 22, to raise money for the Anxiety and Depression Association of America and bring together a community of people who live with the same conditions she does. (Madelyn Reese/Las Vegas Review-Journal)
North Las Vegas marks the opening of Tropical Parkway connector
The City of North Las Vegas, Nevada Department of Transportation and other partners celebrated the opening of the Tropical Parkway connector to Interstate 15 and the Las Vegas Beltway. The stretch of road will make access easier for distribution centers for Amazon, Sephora and other companies moving into an 1,100-acre industrial area rising near the Las Vegas Motor Speedway. (K.M. Cannon/Las Vegas Review-Journal)
Bighorn sheep with West Temple in background at Zion National Park
A bighorn sheep walks through Zion National Park (National Park Service)
Adult Superstore location closes after 45 years
The Adult Superstore on Main Street has closed its doors for good after 45 years. The shop, which offered a multitude of adult toys, novelty items and movies, opened in 1973. Four other locations remain open. A note on the front door tells customers, “We can’t fully express our sorrow.” Adult Superstore was awarded Best of Las Vegas adult store by the Review-Journal in 2016 and 2017 .
Funeral held for Las Vegas corrections officer
Department of Public Safety Correctional Officer Kyle Eng died July 19 after a fight with an inmate at the Las Vegas Jail. A funeral was held for Eng at Canyon Ridge Christian Church Monday, July 30, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
What Back-To-School Shopping Is Like For a CCSD Parent and Teacher
Laura LeBowsky, a CCSD special education teacher and mother of two, set out to shop for her children's supply lists at her local Walmart and Target. She was looking for deals to try to keep the total under $150, while also allowing Chloe, 8, and Brady, 6, some choice in what they wanted. (Madelyn Reese/ Las Vegas Review-Journal) @MadelynGReese
Businesses struggle to fill food manufacturing jobs
Chelten House is a family-owned food manufacturing company from New Jersey. They created a facility in Vegas five years ago and have struggled to find experienced workers in the area. (Marcus Villagran/Las Vegas Review-Journal)
LeBron heckler crosses line, altercation erupts
NBA superstar LeBron James, his wife, Savannah, and daughter Zhuri were at Liberty High School to watch Bronny James in action Wednesday night. But an unruly fan wearing a Michael Jordan Chicago Bulls jersey heckled the newest Los Angeles Laker. The man screamed at event security with LeBron and his family about 150 feet away. The man had to be restrained, triggering a brief altercation with security. James and his family were escorted out a side door along with Bronny's team, the North Coast Blue Chips. Event officials canceled the game between the Blue Chips and Nike Meanstreets.
Las Vegas Oddities Shop in Downtown Las Vegas
Las Vegas Oddities shop owner Vanessa VanAlstyne describes what's for sale in one of the weirder and wackier stores in Downtown Las Vegas. The store opened less than a year ago and carries everything from human bones to "rogue" taxidermy to Victorian death photography. (Madelyn Reese/ Las Vegas Review-Journal)
Trying to Staying Cool in the Las Vegas Heat
Cooling stations like Cambridge Recreation Center's opened across the Las Vegas Valley this week after the National Weather Service issued an excessive heat warning for the area. (Madelyn Reese/ Las Vegas Review-Journal)
Local
Metro Asst. Sheriff Brett Zimmerman on Aug. 8 officer-involved shooting
Metropolitan Police Department Assistant Sheriff Brett Zimmerman met with media Monday to discuss the details of the 14th officer-involved shooting of the year. (Madelyn Reese/ Las Vegas Review-Journal)
Matt Kelly Elementary School hosted its third annual Back-to-School Red Carpet Program
Matt Kelly Elementary School hosted its third annual Back-to-School Red Carpet Program where community and business leaders joined to welcome students back with an inspirational welcome. Bizuayehu Tesfaye/Las Vegas Review-Journal @bizutesfaye
Star Trek fans on show’s enduring popularity
Star Trek fans at the Star Trek Convention 2018 talk about why they think the show has stayed popular across the years Thursday, August 2, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Nonprofit provides clothing for homeless
Sydney Grover of Can You Spare A Story?, talks about how she founded the non-profit organization. (Marcus Villagran/Las Vegas Review-Journal)
Family remembers deceased mother
Family members of Adriann Gallegos remember her. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Camp Broadway teaches kids how to sing and dance
The Smith Center's seventh annual Camp Broadway musical theater program gives 150 kids ages 6-17 an opportunity to learn musical theater skills from industry professionals over a five-day period. Marcus Villagran/ Las Vegas Review-Journal @brokejournalist
Restoring classic Corvettes to perfection
Members of the National Corvette Restorers Society Convention talk about what it takes to earn the NCRS Top Flight Award for a restored Corvette at South Point in Las Vegas on Tuesday July 17, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Watch Ruthless! at Las Vegas Little Theatre
The musical Ruthless! will be playing at Las Vegas Little Theatre from July 13-29. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Cadaver art and sword swallowing at The Dark Arts Market
Curator Erin Emrie talks about her inspiration for The Dark Arts Market at Cornish Pasty Co. in Las Vegas Tuesday, July 10, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
'NO H8' Campaign comes to Las Vegas
Hundreds of locals participate in the NO H8 campaign founded by Adam Bouska and Jeff Parshley as a response to Proposition 8, a California ban on same-sex marriage. The campaign has since evolved to represent equal treatment for all. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
What to expect at Station Casinos' Fourth of July celebration
Station Casinos' is hosting its annual 4th of July celebration with Fireworks by Grucci. Fireworks scheduled to go off on Wednesday, July 4 around 9 p.m. at Green Valley Ranch Resort, Red Rock Resort, Fiesta Rancho and Texas Station. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Star Wars and Golden Knights mashup at downtown art shop
Star Wars and Vegas Golden Knights fans attend the Boba Fett Golden Knight Paint Class at The Bubblegum Gallery in Las Vegas, Friday, June 29, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Tourists and locals enjoy Independence Day fireworks at Caesars Palace
Hundreds of tourists and locals gaze at the Independence Day fireworks show at Caesars Palace on Saturday, June 30, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Clark County recount votes in commission’s District E primary
Clark County staff begin the recount requested by candidate Marco Hernandez in the democratic primary for the County Commission's District E seat on Tuesday, June 26, 2018. (Marcus Villagran/Review-Journal) @brokejournalist
Long-running local hip hop producer wants Vegas rappers to shine
Las Vegas Hip Hop producer and co-owner of Digital Insight Recording Studios Tiger Stylz reflects on 30 years of music production in the city. (Marcus Villagran/Review-Journal) @brokejournalist
"Pawn Stars" fans visit Richard Harrison's memorial at Gold & Silver Pawn
"Pawn Stars" fans from around the world visit the Gold & Silver Pawn Shop in Las Vegas following the passing of Richard "Old Man" Harrison on Monday, June 25, 2018. (Marcus Villagran/Review-Journal) @brokejournalist
Construction for new 51s ballpark underway
New home of the Las Vegas 51s is planned to be finished by March 2019 in Summerlin according to team president Don Logan. (Marcus Villagran/Review-Journal) @brokejournalist
Life
Kids become firefighters at Fire Station 98 open house
Henderson residents wore fire hats, learned about CPR and met firefighters at the Fire Station 98 open house Saturday, August 11, 2018. (Marcus Villagran Las Vegas Review-Journal) @brokejournalist
People from all over the world attend RollerCon 2018
RollerCon 2018 is a five-day convention focused on the roller derby community and culture at Westgate in Las Vegas. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Camp Broadway teaches kids how to sing and dance
The Smith Center's seventh annual Camp Broadway musical theater program gives 150 kids ages 6-17 an opportunity to learn musical theater skills from industry professionals over a five-day period. Marcus Villagran/ Las Vegas Review-Journal @brokejournalist
Las Vegas police officer on being PETA's Sexiest Vegan Next Door
Las Vegas police officer David Anthony talks vegan lifestyle and how he feels about being voted PETA's sexiest Vegan next door from his home on Monday, July 9, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
'NO H8' Campaign comes to Las Vegas
Hundreds of locals participate in the NO H8 campaign founded by Adam Bouska and Jeff Parshley as a response to Proposition 8, a California ban on same-sex marriage. The campaign has since evolved to represent equal treatment for all. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Over 40,000 People Attend The 4th Of July Parade In Summerlin In Las Vegas
Over 40,000 People Attend The 4th Of July Parade In Summerlin In Las Vegas. (Janna Karel Las Vegas Review-Journal)
Star Wars and Golden Knights mashup at downtown art shop
Star Wars and Vegas Golden Knights fans attend the Boba Fett Golden Knight Paint Class at The Bubblegum Gallery in Las Vegas, Friday, June 29, 2018. (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
Bark-Andre Furry meets Capitals superfan Ovie the Bulldog
Two of NHL's furriest fans met at the Forum Shops in Caesars Palace on Tuesday, June 18, 2018, in Las Vegas. Vegas Golden Knights superfan Bark-Andre Furry and Washington Capitals superfan Ovie the Bulldog shared a plate of meatballs and spaghetti with help from Logan, "The Girl with the Hat." (Marcus Villagran/Las Vegas Review-Journal) @brokejournalist
TOP NEWS
News Headlines
Add Event
Home Front Page Footer Listing
Circular
You May Like

You May Like