Manhattan life is getting out.

[rousemark]

I wish people would not offer their opinion on why they think something happened. It's a waste of everyone's time...facts only please

Would be a boring forum.

 

[Medicare bro]

I wish people would not offer their opinion on why they think something happened. It's a waste of everyone's time...facts only please

 

[sman]

I wish people would not offer their opinion on why they think something happened. It's a waste of everyone's time...facts only please

I see that you've not spent much time on forums in general.

 

[annon123]

Who is telling you that Medigap carriers are defrauding taxpayers billions of dollars a year?? Maybe you meant to say MA?

There's not a ton of money in Medigap, and insurance carriers have no way to manage costs. If the underlying risk (fee for service utilization) goes up, the risk premium goes up, too.

If the medigap insurers spent some time trying to pressure medicare into dealing with medicare fraud like provider upbilling, adding existing diagnoses to a visit where that wasn't discussed, etc. that could help them bring their costs down.

 

[somarco]

If the medigap insurers spent some time trying to pressure medicare into dealing with medicare fraud like provider upbilling, adding existing diagnoses to a visit where that wasn't discussed, etc. that could help them bring their costs down.

MEDIGAP carriers are required to pay claims approved by Medicare. They are not allowed to adjudicate or review claims.

Upcoding, prior authorization, delaying and denying claims is the purview of MA carriers.

 

[Midlevel]

Who is telling you that Medigap carriers are defrauding taxpayers billions of dollars a year?? Maybe you meant to say MA?

There's not a ton of money in Medigap, and insurance carriers have no way to manage costs. If the underlying risk (fee for service utilization) goes up, the risk premium goes up, too.

It's not the Med Sups fault that Drs and Hospitals take advantage of patients that are on OM and a Med Sup. It's OM fault for not looking at any of the claims or requiring PA for things such as CT scans, physical therapy and on and on.

Walk into a nursing home sometime and watch them run the Alzheimer's patients through all the different therapies like cattle and collect all that money from OM and Med Sups. Why do you think they all tell people they should get on OM? I guarantee you if a med sup could require prior authorization they would. Them poor bastards are at the mercy of what OM approves which is basically a free for all and the Drs and Hospitals love it.

 

[vic120]

I wish people would not offer their opinion on why they think something happened. It's a waste of everyone's time...facts only please

 

[annon123]

MEDIGAP carriers are required to pay claims approved by Medicare. They are not allowed to adjudicate or review claims.

Upcoding, prior authorization, delaying and denying claims is the purview of MA carriers.

I know that. What I was saying, apparently not well, is that medigap companies would save money if they could get medicare to deal with upcoding, etc. since what would be billed would be less and thus what the medigap had to pay would therefore be less.

 

[somarco]

medigap companies would save money if they could get medicare to deal with upcoding, etc

That would be the tail wagging the dog . . .