Medicare Advantage Plan Patient Reporting Form

Has your retina specialist been dropped from your Medicare Advantage plan?

If so, ASRS wants to hear from you

Insurers across the country are increasingly dropping physicians and other health care providers from their Medicare Advantage plans without cause.

These no-cause terminations put seniors in Medicare Advantage plans at risk of not having  access to highly specialized physicians, like retina specialists.

The American Society of Retina Specialists and other organizations want to protect seniors by instituting policies that would make it more difficult for Medicare Advantage plans to drop physicians from their networks in the middle of the year without cause. Medicare Advantage plans should also be required to provide timely and adequate notice to their enrolled patients about changes to their provider network and should ensure that patients do not experience gaps in care if their physician is dropped.

The American Society of Retina Specialists wants to hear from patients. If your retina specialist has been dropped from your Medicare Advantage plan, please provide as much information as you can regarding your physician's termination. If needed, you can fill out the form multiple times.

Your name is not required. However, should you choose to include your name, the American Society of Retina Specialists may contact you for more information. All contact information provided will be kept strictly confidential.

Complete the online form.

Download the printable form.