Tuesday, September 02, 2014
Larry Weigel: "Private Medicare Advantage Carriers Stand between the Patient and Their Doctors -Not the Federal Government" @ Medicare Coach
So often we hear opponents of the Single Payer Federal Medicare program say: “Don’t Let the Federal Government Stand between You and Your Doctor.” Or, “get government out of the way and let the private sector handle Medicare.”
But, in 2003, when Congress created Medicare Advantage it took away the oversight power from state regulators, and their legal authority to impose sanctions on Medicare Advantage carriers when abuses occur.
This lack of state supervision has allowed insurance companies to expand their role as gatekeepers between the patient and their doctors including overbilling of providers. The Center for Public Integrity investigation published in June of 2014, “found as much as $70 billion of improper payments to Medicare advantage plans from 2008 through last year.”
Congress granted the oversight authority of Medicare Advantage plans to the understaffed and underfunded government run Centers for Medicare and Medicaid Services organization (CMS), but the agency cannot keep up with the demand for audits.
In March of 2014, CMS officials said they were “constrained in the number of program audits we can conduct each year due to limited resources.” According to the Center for Public Integrity’s August 2014 report, “The agency is only able to audit about 30 Medicare Advantage companies a year, about one in ten of the 300 operating.”
Recently, we received a call from a Medicare Advantage beneficiary in Kansas City telling us her doctor would not accept her Advantage plan. Then she scheduled an appointment at the Cleveland clinic, and her Medicare Advantage carrier said they won’t pay because the clinic is an out of network facility.
Traditional Medicare (the government kind) will pay anywhere in the United States wherever a medical provider accepts Traditional Medicare.
More benefit payment problems with private Advantage plans are now occurring around the country because lack of state regulation.
The Center for Public Integrity reported in an August 19, 2014 article, “When Minnesota retiree Doug Morphew needed surgery last year, he expected his Humana Medicare Advantage plan to step up and pay the lion’s share of the bill.”
Morphew said, “The health plan had told him over the phone he would owe just $450 for the two days he spent in a St. Paul hospital recovering from the operation to repair an aortic aneurysm.”
“Less than a month later, Humana hit him with a bill for $6,461.66 claiming the surgery was not covered because the hospital was “out of network,” the article stated.
In an interview with the Center for Public Integrity, Morphew said, “Humana paid the bill, but only after several months of fighting with them after he filed an affidavit with the Minnesota Attorney General’s office last year.”
“It was a nightmare,” Morphew said.
This is just one example of why, our Kansans to Preserve Medicare group opposes The Health Care Compact bill passed by the Kansas legislature in April of 2014, to grant private insurance companies the authority to take away the management of Medicare from the Federal government for the 450,000 Medicare beneficiaries living in Kansas.
Any politician advocating this non-sense of removing Kansas from the Federal Medicare program must be challenged. Every Medicare beneficiary should stand up and be counted to protect their guaranteed Medicare benefits already in place.
Even though we have very few of our 500 coach members on Medicare Advantage plans, we will no longer recommend these plans for any of our new members because insurance companies along with some members of Congress advocating these Advantage plans, have now turned the private side of Medicare into a Medicare Advantage insurance market.
It is a product sale that provides a substantial source of income for the carriers. Membership is growing in these plans because of generous tax payer subsidies provided to the insurance carriers which allow them to attract new members with additional benefits not provided to those enrolled in Traditional Medicare plans.
Some members of Congress who want to privatize Medicare are looking the other way, and allowing lobby pressure to cloud their judgment, but fill their campaign coffers with lobby contributions, as they continue to offer generous tax payer subsidies to Medicare Advantage providers without addressing the fairness issue for Traditional Medicare members who do not receive these extra overpayments and extra benefit perks.
Buyers beware as you watch the “Too Good to be true” Medicare Advantage commercials on T.V. coming soon. Medicare Advantage plans do have maximum out of pocket risks of up to $6700.
If you want to lower your premiums, you can get a Medicare Supplement high deductible insurance plan for $35 per month under Traditional Medicare with a maximum out of pocket risk of $2140, and avoid the “out of network” provision, and go to any doctor of your choice in America who accepts Medicare.
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To receive blog update alerts, send your email address to firstname.lastname@example.org We have partnered with the Kansans to Preserve Medicare group and now their list has grown to more than 550 members. Very few Medicare members are aware of the Health Care Compact Bill and need to know, so please forward these email updates to your Medicare friends and encourage them to get involved. Or, go to our website www.mymedicarecoach.com to read past posts about Medicare issues affecting Kansans and Medicare beneficiaries living in the other eight states who are part of the compact group. (Utah, Texas, Oklahoma, Missouri, Indiana, Alabama, South Carolina and Georgia.)