Reuters: US charges 193 people in $2.75 billion health care fraud bust

[Midlevel]

It's a terrible thing to keep your doctor and have them in charge of your healthcare

Love how everyone thinks Drs are like God. Remember they are just regular people who had the dedication to put 12 years of their life on hold to get a degree. They don't teach them about insurance in those 12 years. All have financial incentives to pay off the huge loans along with getting bonuses from the hospital or clinic they are affiliated with based on amount of revenue brought in.

The concept that they should just have a blank check to do whatever the hell they want without any oversight blows my mind. Why do we need PA for 64 years but once they turn 65 nothing should be questioned?

 

[goillini52]

Meanwhile back on the farm.

32 health systems dropping Medicare Advantage plans | 2024

"Learn about the growing trend of hospitals and health systems dropping Medicare Advantage plans due to administrative challenges, including prior authorization

www.beckershospitalreview.com

Fear mongerer!!!

 

[rmhaire]

Fear mongerer!!!

You caught me. I made it all up.

 

[MedicareWAA]

Makes one wonder how many other cases are in the works but under wraps. Providers, payers, agents, etc

 

[Yagents]

Love how everyone thinks Drs are like God. Remember they are just regular people who had the dedication to put 12 years of their life on hold to get a degree. They don't teach them about insurance in those 12 years. All have financial incentives to pay off the huge loans along with getting bonuses from the hospital or clinic they are affiliated with based on amount of revenue brought in.

The concept that they should just have a blank check to do whatever the hell they want without any oversight blows my mind. Why do we need PA for 64 years but once they turn 65 nothing should be questioned?

You're backwards.

1. They are not gods, but they know more about actual patients and medical care then some computer algorithm or high school grad working the phones at carrier.

2. Yup, they donate 12 yrs for the good of humanity and leave with lots of debt, with no ability to control the amount they are paid (like a lawyer), and subject to agreements negotiated by someone else.

2. Last time I checked, people aging at 65 get sicker and more frail, and need care from a professional, not some *** at a carrier.

4. They don't know insurance, just like we don't know medical assessment and advice. Agents and doctors can't be experts in both.

5. Maybe he will have loan paid off by age 50, and has only 25 years to make a living and save for retirement.

6. We have massive shortage of Dr and nurses already. Go ahead and make it a more attractive career by adding on additional burdens. See how that turns out

 

[Midlevel]

You're backwards.

1. They are not gods, but they know more about actual patients and medical care then some computer algorithm or high school grad working the phones at carrier.

2. Yup, they donate 12 yrs for the good of humanity and leave with lots of debt, with no ability to control the amount they are paid (like a lawyer), and subject to agreements negotiated by someone else.

2. Last time I checked, people aging at 65 get sicker and more frail, and need care from a professional, not some *** at a carrier.

4. They don't know insurance, just like we don't know medical assessment and advice. Agents and doctors can't be experts in both.

5. Maybe he will have loan paid off by age 50, and has only 25 years to make a living and save for retirement.

6. We have massive shortage of Dr and nurses already. Go ahead and make it a more attractive career by adding on additional burdens. See how that turns out

Not trying to convince you otherwise because you have your opinion. Just blows my mind that you think Drs should have a blank check to fill out anytime they want. Would work perfectly if 100% of them were honest and ethical. Gonna go out on a limb and guess they aren't, just like us bitching about all the rogue medicare agents that are out doing illegal shit and stealing clients from honest agents like yourself.

What I don't get is if MAPD's are so terrible, why do millions more sign on each year and very few leave them. I've got over 700 on MAPD and none are fighting to go back to OM and a MS. Guess I'm just lucky in my area. I will quit posting about it again now and go back to just reading.

 

[Yagents]

No fraud in MAPD either I guess

How insurers use doctors to profit off medical codes

Insurers like UnitedHealth are profiting off of the Medicare Advantage system, and it's causing problems for both doctors and patients. Watch to learn more.

www.statnews.com

Traditional Medicare is run by the federal government, while Medicare Advantage health insurance plans are operated by private companies like UnitedHealth. These privately run plans are still subsidized by government funds. Medicare Advantage insurers are paid a set monthly amount for each of their members regardless of whether they received care that month or not. That amount is based on each patient's personal risk score. The sicker the patient is, the higher their risk score, and the bigger the check insurers receive from the government.

This system is intended to prevent insurers from favoring healthier people over those who have illnesses, but it also leaves room for insurers to make more money by making their patients appear as sick as possible.

Watch this video to understand more about how private insurers can use this coding system to increase their profit.

 

[rmhaire]

What I don't get is if MAPD's are so terrible, why do millions more sign on each year and very few leave them. I've got over 700 on MAPD and none are fighting to go back to OM and a MS. Guess I'm just lucky in my area. I will quit posting about it again now and go back to just reading.

1st is human nature. When presented with a choice between paying a premium or getting it free, it's simply human nature to lean toward free.

2nd is what they see. All of the ads are about to crank up. We'll see 50 to 100 MA ads for every OM ad. I'll probably need a wheelbarrow just to get Humana's crap out of my mailbox.

3rd is what they are told. A lot of the newer agents never mention supplements in their 101. That's how they've been trained. When they compare an MA plan against OM, MA will win every time.

4th. There are plenty of people wishing that they can change. Some can't and some don't know how.

5th. Don't stop posting. I enjoy reading them. We don't always have to agree.

 

[Midlevel]

1st is human nature. When presented with a choice between paying a premium or getting it free, it's simply human nature to lean toward free.

2nd is what they see. All of the ads are about to crank up. We'll see 50 to 100 MA ads for every OM ad. I'll probably need a wheelbarrow just to get Humana's crap out of my mailbox.

3rd is what they are told. A lot of the newer agents never mention supplements in their 101. That's how they've been trained. When they compare an MA plan against OM, MA will win every time.

4th. There are plenty of people wishing that they can change. Some can't and some don't know how.

5th. Don't stop posting. I enjoy reading them. We don't always have to agree.

But what is the point of posting the same stuff over and over again? I get drawn in and can't keep quiet and then it just stresses me out.

Neither side is going to change just like politics. Not sure if you noticed but I never talk politics and think they are all a bunch of idiots on both sides. Just try to keep to myself and do what's best for my family and I and don't worry about everyone else. I am much happier that way. Thank you for being civil.