Becker’s Hospital Review, the hospital industry’s own trade publication, counts roughly 25 major health systems that have dropped or significantly narrowed Medicare Advantage this year, and the list is still growing. Mayo Clinic left most Advantage plans from UnitedHealthcare and Humana. UNC Health cut Humana, WellCare and old Cigna plans. And Johns Hopkins Medicine went out of network with UnitedHealthcare’s Advantage plans.

The dispute comes down to who pays, and how fast. Under the original government-run Medicare, a hospital does what it needs to do for the patient, sends the bill and just gets paid — very simple. But under many of these for-profit Medicare Advantage plans, the hospital has to beg the insurance company for permission first — a process called prior authorization — and then still often has to fight to get paid after they deliver the care.

To dig deeper, visit the original article on the Thomson Reuters blog.