Several major payers are shaking up their partnerships and coverage options heading toward 2024, with several big moves impacting orthopedics:
1. Cigna healthcare has expanded its Medicare Advantage plans to patients in Nevada for the first time. Orthopedic patients in Nevada can now have access to Cigna Medicare Advantage for coverage.
2. Louisville, Ky.-based Baptist Health could be going out of network with UnitedHealthcare for certain Medicare enrollees after its contract with the payer expires on Jan. 1. UHC patients seeking care within the system could be impacted if the contract does expire before an agreement is reached.
3. Cleveland-based University Hospitals has launched a co-branded Medicare Advantage Plan for individuals in three Ohio counties in partnership with PrimeTime Health Plan. The plan will give members access to University Hospitals' network of facilities and providers, including more than 3,300 orthopedic, oncology and heart and vascular specialists.
4. CVS Health-owned health insurance provider Aetna announced its 2024 Medicare products, the largest Medicare offering in its history.
5. Payers could be determining the future of orthopedics, according to surgeon Michael Redler, MD. As the orthopedic industry continues to innovate, insurance companies are going to play a large role in determining what patients are eligible for what new technology options.
6. UnitedHealthcare announced plans to reduce 20 percent of its prior authorization volume. On Nov. 1, three orthopedic-related surgery codes will be eliminated from prior authorization requirements for UHC's Oxford plan holders.
7. UHC is also taking steps to remove prior authorization requirements for several spine codes and orthotics/prosthetics codes in its Medicare Advantage and Oxford plans.