Hot Medicare News

[goillini52]

I get the impression he thinks we should just put them down.

That's what I was trying to get him to say.

 

[TheMedicareWizard]

So it’s a benefit for the entire Medicare program for providers to be able to do whatever the hell they want to increase profits. Have none of you ever been to a Drs appt with your parents or in a nursing home and see what goes on. It’s like you have blinders and just think there are unlimited funds for the Medicare program and all the fraud. You wouldn’t believe how many kids have been with their parents at appt. and start spouting off I’ve worked in SNF or friend has and stay away from MA. They have to get approval for therapy and to stay more days etc. I tell them that’s a good thing and that’s the reason Med Sups go up every year. Once I start to tell them the ins and outs of how it all works it kind of makes them think a bit that maybe it’s not a good thing.

You're so close to seeing the point it's practically stabbing you in the eye.

 

[rousemark]

Utilizing the benefits that I pay more for is "milking the system"?

Would you not think that getting free hearing benefist, vision benefits, transportation, money of OTC items be what you really call milking the system?

 

[sshafran]

Doctors have scammed me out of thousands of dollars.

I'm sure they've scammed Medicare out of millions. Billions.

Numerous needless tests - and they are sneaky sneaky about it. They are masters at the upsell (and we are unsuspecting).

"Head back there and we'll go ahead and do _______. Then we'll schedule you for ________." (Cue the nurse smiling - asking you to follow. No discussion of price.)

$3,000 later....

 

[sshafran]

Doctors have scammed me out of thousands of dollars.

I'm sure they've scammed Medicare out of millions. Billions.

Numerous needless tests - and they are sneaky sneaky about it. They are masters at the upsell (and we are unsuspecting).

"Head back there and we'll go ahead and do _______. Then we'll schedule you for ________." (Cue the nurse smiling - asking you to follow. No discussion of price.)

$3,000 later....

We have gotten better (by experience) at asking "Why" at just about every turn. We often now say "No" to the doctor.

Take your kids in for a routine xyz if you aren't careful they'll look for new ways to charge you.

And don't get me started on the excess charges and unnecessary tertiary and not medically necessary tests associated with Maternity. They would ultrasound bi-weekly if you let them...

 

[sshafran]

Last thought on my mini rant - ie this is my point.

Cost sharing could be the biggest driver in keeping things in check. Put another way, if I had Plan F, I wouldn't care at all what they did. "Oh, you need to run a test? Cool - it's free. I'm sure it's needed."

(I'd also advocate, on the MAPD side, that we eliminate the star system which is being played like a fiddle by the smarter carriers.)

 

[LostDollar]

Caveat, not an agent.

Cost sharing can also cause a person not to see a doc when maybe they should.

 

[somarco]

(I'd also advocate, on the MAPD side, that we eliminate the star system which is being played like a fiddle by the smarter carriers.)

Any kind of rating system, including stars, are eye candy for consumers.

Insurance carriers are very good at marketing junk and making it look like a deal you can't afford to pass up.

And copays should be banned on all plans. Before drug copays became popular, comprehensive major med plans all had calendar year deductibles that typically ran from $100 to $500. (This is back in the 80's when that level of deductible was considered huge).

Typical early copays were $1 for generics, $3 for most brand names.

The carrier I worked for at the time noticed that Rx claims were going through the roof on plans with drug copays. Drug claims jumped over 20% in one year, all because of copays.

And there was no such thing as a doctor copay at the time.

People quickly became CONDITIONED to believing they could not see a doctor, or fill a prescription, unless the plan had a copay.

Too bad we can't . . . turn back time . . .

 

[Travis Price]

CMS knows they are terribly understaffed and the amount of daily fraud is rampant on original medicare. Wonder why the Part B premium, Part B deductible and the Med Sup premiums all go up each year?

Umm.. as someone that worked with CMS, SSA, Fraud and Disability.. I can tell you that the government is absolutely investing more and more into fraud investigations because there is a significant return on investment.

However, you really don't know what you're talking about here.

MAPD is costing millions in Medicare funds by miscoding. They're saving millions of dollars by denying claims inappropriately.

Access to quality care isn't JUST the network.
It's approving claims that should be approved the first time.
It's not making clients jump through hoops to get medically necessary care.

It's not needing to appeal decisions that are wrong. Which most people don't do, and most denials are overturned in appeal.

 

[rousemark]

Umm.. as someone that worked with CMS, SSA, Fraud and Disability.. I can tell you that the government is absolutely investing more and more into fraud investigations because there is a significant return on investment.

However, you really don't know what you're talking about here.

MAPD is costing millions in Medicare funds by miscoding. They're saving millions of dollars by denying claims inappropriately.

Access to quality care isn't JUST the network.
It's approving claims that should be approved the first time.
It's not making clients jump through hoops to get medically necessary care.

It's not needing to appeal decisions that are wrong. Which most people don't do, and most denials are overturned in appeal.

When I was undergoing treatment for cancer, I was so thankful I did not have to worry abut networks and pre approvals. There is enough stress involved without having to worry about all that garbage.