As is widely recognized, Medicare Advantage co-pays continue to increase, while coverage policies are becoming increasingly restrictive. At the same time, CMS continues to provide substantial bonuses to Medicare Advantage plans and appears to be moving toward broader adoption of Medicare Advantage, potentially through automatic enrollment mechanisms that may limit choices for Medicare beneficiaries.
Included below is an update regarding CarolinaEast Medical Center and its decision to discontinue participation with Blue Cross Blue Shield and UnitedHealthcare Medicare Advantage plans. This information was provided by Giovanna Garcia.
CarolinaEast Medical Center’s decision to drop Blue Cross Blue Shield and UnitedHealthcare Medicare Advantage plans after describing payment policies, denials and reimbursement delays as “financially and operationally unsustainable” for the hospital.
CarolinaEast is part of a growing national trend.
Hospitals and health systems across the country are increasingly severing ties with Medicare Advantage plans, citing growing frustration with prior authorization delays, claims denials, and slow reimbursement processes.
- Becker’s Hospital Review reports that 21 health systems dropped Medicare Advantage plans in 2026 amid growing reimbursement and operational disputes.
With Medicare Advantage now covering 55% of eligible Medicare beneficiaries nationwide — more than 35 million seniors — these disputes are becoming increasingly consequential not only for providers and payers, but also for patients who could lose access to care as more hospitals reconsider participation in Medicare Advantage networks.
Providers say the issue is no longer just whether claims are eventually paid — it’s the operational burden required to get paid at all.
- A March 2026 AHA report found hospitals spent $43 billion in 2025 pursuing payments tied up in denials, prior authorizations, and repeated documentation requests.
Many claims are ultimately reimbursed, but only after repeated follow-ups, appeals, resubmissions, coding corrections, and manual intervention across revenue cycle teams.
MedEvolve refers to this growing operational burden as the “denials tax” — the cumulative rework, follow-up activity, and administrative effort required to move claims from submission to payment.
According to Matt Seefeld, CEO of MedEvolve, denial rates alone fail to capture the true operational strain hospitals are facing.
“A denial rate only measures the outcome,” Seefeld says. “It doesn’t measure how much work it actually takes to recover reimbursement. A claim may be reimbursed, but if it required five or six staff interactions to get there, the organization has absorbed a real operational cost.”
Seefeld can speak to what’s driving the growing backlash against Medicare Advantage plans, why hospitals are increasingly describing payer relationships as financially and operationally unsustainable, and how many organizations are beginning to rethink denial rates as a standalone revenue cycle KPI.
This whole scenario is outragious and unfair to our seniors!
The new guidelines and protocols for performing MedialBranchBlocks, as an example, is ridiculous.
Every tiome you suggest doing an MBB, you need to state that the goal is RFA. In addition, x-rays may not be good enough, so lets get an MRI and have the patient pay a higher co-pay in the meantime.
Finally, lets be cruel and complete 2 “diagnostic blocks” (that last maybe 2-4 days and then have the patient wait 1 month to get a similar injection so that by the 3rd month, they finally get the definitive RFA! Inthemeantime,let’s Rx Opioids,exercise, and NSAIDS.
System is nuts. It has been well thought out to effectively restrict patients the standard of care and go back to Opioids.
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