Medicare Advantage, More Oversight, Less Overpayment

[MedicareWAA]

@MedicareWAA you are a real class act. Do you want to meet me after school for a fight?

What an immature response. Ad hominem attacks always show intelligence.

I’ll edit to replace “you’re retarded” with “you are not a smart person”.

 

[renee15]

The reason providers don't like Medicare Advantage is simply rooted in their own self-interest. Medicare Advantage plans are much more paperwork, less pay (on average), and more regulations.

Original Medicare is "fee-for-service" and there are almost absolutely no checks and balances. Which means a doctor can bill a unicorn and a giraffe and get paid.

Medicare Advantage is a "healthy outcomes" model, which means providers are graded on how healthy they ACTUALLY keep their patients. They don't like that.

Why? Because the ones that are running fraudulent schemes can't get away with it on Medicare Advantage, and the ones with tons of kickback deals with big Pharma know if they keep throwing tons of toxic pills at their patients, they might end up getting really sick, and then their health grade goes way down, as does their payments from Medicare Advantage.

There is a good bit of fraud in original Medicare ($60 BILLION dollars a year's worth), and a lot of people don't understand that the major culprits are some hospitals, doctors, nurses, testing facilities, etc. This is the REAL reason why they hate Medicare Advantage....there's oversight.

Here's a great example.....just Google "Medicare fraud," click on "news," and then start reading. This fraud is all from original Medicare. Just a taste of the headlines....

https://www.cnn.com/2024/06/27/us/health-care-fraud-crackdown/index.html

"More than 190 defendants, including 76 doctors, nurse practitioners and other licensed medical professionals, were charged over two weeks in federal courts across the country, according to the Justice Department, and the government has seized more than $231 million in cash, luxury vehicles, gold and other assets."

If you supplement-only guys keep running a campaign against Medicare Advantage, as a strategy, none of us are gonna have jobs soon enough.

Regulators have no clue about anything insurance, and all they hear is guys like you bashing the program. As a result, they group all agents under the same umbrella and start HEAVILY regulating it all, which is what we've seen over the course of the past 5 years.

I have tons of clients on Medicare Advantage, and they are consistently very happy clients. My own parents have been on them for 15 years and they've never had a complaint.

I also have tons of clients on Medigap, and they also are consistently happy with those. Whichever one they choose, I don't care, as long as they're happy.

Are there some prior authorizations on some services? Yes. Do my clients ever not get the care they need? No. It might not be everyone's cup of tea, but MANY people are just fine with having some authorizations. It's no different than how 90% of people currently get their insurance in this country.

There is a place for both MAPD and Medigap. This is a time where agents need to be UNITED, because I hate to break it to you, but they're coming after us all. Supplements are also very much regulated by the government. If you think you're safe, you're not.

All health insurance is highly regulated, nowadays. Not nearly as much as Medicare Advantage, but the fact remains that supplements could be wiped out with the stroke of a clueless communist politician's pen, too.

Original Medicare denies claims if not coded correctly or if the provider isn't contracted to take medicare. "Original Medicare is "fee-for-service" and there are almost absolutely no checks and balances. Which means a doctor can bill a unicorn and a giraffe and get paid."

 

[renee15]

My source is my provider friends I have who literally say “God I hate Medicare Advantage.” And then I pressed them on why and they told me….tons of extra paperwork and headaches. This is also just basic reasoning. Who are they gonna like more? The side that involves minimal paperwork, no extra regulations, no oversight, or the side that involves the opposite?

I had two claims denied this year, so this is from personal experience. They were resubmitted. If the provider accepts Medicare, they can't bill me if Medicare doesn't pay. ( G plan doesn't pay if Medicare doesn't pay)

 

[goillini52]

I had two claims denied this year, so this is from personal experience. They were resubmitted. If the provider accepts Medicare, they can't bill me if Medicare doesn't pay. ( G plan doesn't pay if Medicare doesn't pay)

That's true with any Med Supp Plan. Medicare determines if and how much the Med Supp pays.

 

[DNicholsIns]

The US healthcare system is expensive, and that's why there are so many frauds being committed every day. This law firm mentions some of them, but the list is not full. I don't know how to fix this and if there is a way to fix it.

 

[rmhaire]

The US healthcare system is expensive, and that's why there are so many frauds being committed every day.

I agree. Way too many frauds.

Healthcare needs to be redesigned.

We could start with hospital gowns.

Why do they have to open from the rear?

 

[somarco]

68 million people on Medicare.

6,000 hospitals
1.1 million doctors
4 million nurses
2.6 million assistant healthcare workers

An untold number of government employees and agencies responsible for oversight . . . yet it takes years to uncover fraud and bring up charges.

Please don't tell me we need MORE government workers.

As for hospital gowns, if you don't like them openng in the back, turn it around and have it open in the front.