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Post by anitya on Oct 2, 2022 4:25:16 GMT
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Post by anovice on Oct 9, 2022 15:22:53 GMT
'The Cash Monster Was Insatiable': How Insurers Exploited Medicare for Billions "The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne or a bonus in their paycheck. Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again." www.yahoo.com/news/cash-monster-insatiable-insurers-exploited-162553795.html |
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Post by anitya on Oct 14, 2022 2:05:46 GMT
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Post by Chahta on Oct 17, 2022 0:59:50 GMT
'The Cash Monster Was Insatiable': How Insurers Exploited Medicare for Billions "The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne or a bonus in their paycheck. Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again." www.yahoo.com/news/cash-monster-insatiable-insurers-exploited-162553795.htmlIt is such s a dirty game. I do not buy an Advantage plan (Part C Medicare), I subscribe to Part B Medicare. But I found out a couple of months ago about shenanigans that Medicare plays. They contract with insurance companies to operate something called Direct Contracting Entities (DCEs). The insurance company acts like an Advanatage Plan by contracting with doctors groups that have patients like me on Part B Medicare. Medicare gives the insurance companies an amount of my benefit, ahead of time. They "work" with the doctors group to "manage" my health by giving them part of my Medicare benefit paid ahead of time. In effect they have turned my Part B into an Advantage plan without me knowing. The insurance company gets to keep up to 40% of what Medicare gives them on behalf of me for "profits" if not spent on me. The letter I received from the insurance company operating the DCE told me "they will guard my records, help my doctor manage my health", when I never requested nor wanted another insurance company involved in my health. The bottom line is the insurance company will do it needs to do to make a profit from my health. My only recourse is to quit my doctor and find another. I understand that Medicare gave them access to 2 years of my medical records to set this DCE, without my say so or any notification. Medicare pays out nominally $12,000 per year for each beneficiary. Alot of money to cheat and get a part of. The theory about DCEs is to cut costs for Medicare by having an intermediary insurance company monitor my claims and what services the doctor provides to me. |
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Post by anovice on Oct 17, 2022 19:15:54 GMT
Chahta, since you do not have a Medicare Advantage plan do you have Original Medicare and a Medicare Supplement plan?
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Post by Chahta on Oct 21, 2022 1:47:13 GMT
Chahta, since you do not have a Medicare Advantage plan do you have Original Medicare and a Medicare Supplement plan? I have Medicare and a supplement plan, but the DCE starts to act similar to an Advantage plan. I object as this was done without my knowledge. I only became aware of it because the insurance company was required to send notification without really describing what was happening. I had to investigate online to figure it out. Additionally I found out that Medicare gave the insurance company the right to review 2 years of my medical information. |
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Post by habsui on Oct 21, 2022 5:41:09 GMT
I have read that DCE is being changed in 2023. New term, ACO REACH. Clearly, a longer acronym will make this better..
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Post by marquay on Oct 21, 2022 11:53:27 GMT
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Post by anovice on Oct 21, 2022 12:24:09 GMT
Chahta, since you do not have a Medicare Advantage plan do you have Original Medicare and a Medicare Supplement plan? I have Medicare and a supplement plan, but the DCE starts to act similar an Advantage plan. I object as this was done without my knowledge. I only became aware of it because the insurance company was required to send notification without really describing what was happening. I had to investigate online to figure it out. Additionally I found out that Medicare gave the insurance company the right to review 2 years of my medical information. Indeed, it is nasty. And currently, while your only recourse is to quit your doctor and find another, this will not work forever. By 2030 when everyone is in one of these, there will not be a way to opt-out because there won't be any primary care doctors that are not in it. Buckle up for Social Security changes! |
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Post by Chahta on Oct 21, 2022 12:56:19 GMT
I will say that I still have the Part B right to go to any doctor of facility as long as they take Medicare. My primary care doctor is in a very large group. He would love for me to use nothing but his group but I use who I want. Before the DCE it was only about health care between my doctor and me. Now with Humana (the insurance company) it is about profit for them. I did put my doctor on notice that I am not happy with his decision to go DCE.
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Post by Deleted on Oct 21, 2022 12:57:16 GMT
I have Medicare and a supplement plan, but the DCE starts to act similar an Advantage plan. I object as this was done without my knowledge. I only became aware of it because the insurance company was required to send notification without really describing what was happening. I had to investigate online to figure it out. Additionally I found out that Medicare gave the insurance company the right to review 2 years of my medical information. Indeed, it is nasty. And currently, while your only recourse is to quit your doctor and find another, this will not work forever. By 2030 when everyone is in one of these, there will not be a way to opt-out because there won't be any primary care doctors that are not in it. Buckle up for Social Security changes! And the 80,000 new IRS agents. |
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Post by chang on Apr 19, 2023 16:46:01 GMT
I have been tempted to sue Cigna several times. Once I did haul there a$$es in front of the CIFO (Channel Islands Financial Ombudsman) over a claim. Long story. I had a global health insurance with them for 3-4 years; and I finally dumped them a couple of months ago. They are the most incompetent and inept company I have ever dealt with, and you can add the adverbs egregiously, horrendously, outrageously, incredibly, hideously, shockingly, atrociously, and appallingly. Their customer service is worse than non-existent; it qualifies as abuse. Their IT systems are utter dreck. I'll stop there. I wouldn't own their stock if you gave it to me. If I were a trillionaire, I would buy the company and flush it down the loo. |
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Post by anitya on Apr 19, 2023 20:49:56 GMT
chang , What prompted you to post about Cigna now? Do you want to share more / latest on Cigna. My parents have their Medicare supplemental through Cigna and while I do not have the depth of your experience with them, I did notice that they are nothing to write home about. I just assumed all health insurance companies are somewhat archaic and bureaucratic (simply serving their executives?). Interestingly, I had a horrendous experience with United Health on a policy renewal more than 12 years ago and always avoided them after that, even if they were cheaper but I notice that they are a darling of the investor community. P.S.: I just realized that @haven no longer is a member here. He was not deleting his off topic post, even after my request and so I did not delete my request as promised. Now, it is past due when I can delete. Do you mind deleting my last two posts in this thread so I can honor at least @habsul and @chahta? Thanks.
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Post by archer on Apr 20, 2023 1:58:55 GMT
anitya, It's been some time since you asked about kaiser, but I will offer that I have been very happy with them since the mid '80s. If you travel a lot it could result in some snags for out of area services. Some kaiser facilities have better reputations than others, but they seem to all rank from good to excellent. I like not having to find specialists on my own, but I guess non HMO patients can easily get referrals from their dr. The only drawback as I see it is that if I want a procedure or lab tests that are not considered by kaiser to be needed, they will not even perform them if I wanted to pay out of pocket. As far as insurance coverage I suppose HMO or not, insurance companies nor medicare would pay for anything that wasn't deemed important. I don't have any personal experience outside of kaiser to compare to other than a few years in the early 80's when I was 100% covered by medi-cal (CA state insurance). IMO the system of insurance paid medical care is very convoluted and kaiser does make it much simpler. Personal experience, when my daughter was born during the few years I was on Medi-cal, her birth was at what was considered to be the best hospital in the bay area for obstetrics. My son was born at Kaiser and they were much more on top of it.
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Post by anitya on Apr 20, 2023 2:20:47 GMT
Thanks, archer. I decided to stay with the HMO plan I had which was 15-20% cheaper than Kaiser. When my health needs change (I hope not), I will switch over to Kaiser so it is a one stop shop. Thanks. |
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Post by chang on Apr 20, 2023 6:30:15 GMT
chang , What prompted you to post about Cigna now? Do you want to share more / latest on Cigna. My parents have their Medicare supplemental through Cigna and while I do not have the depth of your experience with them, I did notice that they are nothing to write home about. I just assumed all health insurance companies are somewhat archaic and bureaucratic (simply serving their executives?). Interestingly, I had a horrendous experience with United Health on a policy renewal more than 12 years ago and always avoided them after that, even if they were cheaper but I notice that they are a darling of the investor community. P.S.: I just realized that @haven no longer is a member here. He was not deleting his off topic post, even after my request and so I did not delete my request as promised. Now, it is past due when I can delete. Do you mind deleting my last two posts in this thread so I can honor at least @habsul and @chahta? Thanks. Because I finally dumped them a short while ago, and while searching happened to see the post. I will attend to the deletions now. Too much to share about Cigna. I will just add that their web site is utter crap. They couldn't update my address or banking information after three years of trying. I had to call Scotland to get someone in customer service, who NEVER knew anything. You can request a call-back from their web site, and they NEVER call you back. You can send messages to customer service, but they go into a black hole. I will go so far as to say that Cigna is not just grotesquely incompetent, but probably borders on fraud, hence my previous use of the term “customer abuse”. I don't mind bureaucrats if they're good at what they do; Cigna isn't. |
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Post by yogibearbull on Apr 22, 2023 12:31:47 GMT
Cigna/CI, United Health/UNH, Aetna/CVS (now) have all been in our state/IL plans. When the state switches every 10 years or so, there isn't really a choice for us. Most of the experiences have been similar.
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Post by johntaylor on May 2, 2023 14:54:36 GMT
Visiting PA where the talk is whether HMO style will require gateway doc for access to specialists:
"Danville, Pa.-based Geisinger's acquisition by Oakland, Calif.-based Kaiser Permanente will take 'everything that people are familiar with and love about Geisinger and [build] on that to bolster it and sort of give it that turbo-boost,' Geisinger CEO Jaewon Ryu, MD...Geisinger will be the first to join Risant Health, a new nonprofit organization that aims to expand and accelerate the adoption of value-based care in "diverse, multi-payer, multi-provider, community-based health system environments.'
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