StephanieCJ
Guru
- 660
So, to summarize Trump's executive order, Chris Westfall is a lying snake.
Yep, nothing new there!
Trump to sign Executive Order on Medicare Advantage
- Thread starter craig_ritter
- Start date
Move on..........no problems here:
Hospitals call for overhauling Medicare Advantage prior authorization rules
Hospitals call for overhauling Medicare Advantage prior authorization rules
Hospitals and health systems are demanding that the CMS set national rules for how insurers manage prior authorization and payment for pre-approved claims in Medicare Advantage.
In response to the Trump administration's request for information on its Patients over Paperwork initiative to cut Medicare red tape, hospitals complained that prior authorization is a complicated system where payment isn't guaranteed even if they follow all the steps insurers lay out for them.
They want national standards so that clinicians will know what they have to do to get treatments approved regardless of the insurer and to ensure they get paid.
"You follow the payer's rules, you think, 'Wow that was an easy process,' you thought you have checked all the boxes to get the procedure paid, only to be denied," wrote Laurie Pierce, director of patient financial services for 25-bed North Valley Hospital in Montana.
She complained also that the appeals process is burdensome. On average she has had to appeal unpaid Medicare Advantage claims at least three times. Even if an appeal is successful, it can take six months to a year to get paid, Pierce noted.
For Dr. Timothy Dellit, chief medical officer for University of Washington Medicine, the rules around prior-authorization simply need to be clearer. Medicare insurers should state "when and why pre-authorization is not needed," he said.
Hospitals call for overhauling Medicare Advantage prior authorization rules
Hospitals call for overhauling Medicare Advantage prior authorization rules
Hospitals and health systems are demanding that the CMS set national rules for how insurers manage prior authorization and payment for pre-approved claims in Medicare Advantage.
In response to the Trump administration's request for information on its Patients over Paperwork initiative to cut Medicare red tape, hospitals complained that prior authorization is a complicated system where payment isn't guaranteed even if they follow all the steps insurers lay out for them.
They want national standards so that clinicians will know what they have to do to get treatments approved regardless of the insurer and to ensure they get paid.
"You follow the payer's rules, you think, 'Wow that was an easy process,' you thought you have checked all the boxes to get the procedure paid, only to be denied," wrote Laurie Pierce, director of patient financial services for 25-bed North Valley Hospital in Montana.
She complained also that the appeals process is burdensome. On average she has had to appeal unpaid Medicare Advantage claims at least three times. Even if an appeal is successful, it can take six months to a year to get paid, Pierce noted.
For Dr. Timothy Dellit, chief medical officer for University of Washington Medicine, the rules around prior-authorization simply need to be clearer. Medicare insurers should state "when and why pre-authorization is not needed," he said.
It doesn't surprise me in the least that politicians can't distinguish between MA and Original Medicare. 99% of the population, including many insurance agents, and including about 44 million Medicare beneficiaries, don't understand it either.
What does bother me is that someone holding themselves out there as an expert would put out such a biased video. He slams all MA plans as rotten, untrustworthy, guilty of using misleading sales and marketing practices, and ripping off the government. He used to not sell MA plans at all, but now he admits to it being at least 10% of his business. Does he not care about that 10%? He also claims that he only takes certification so that he can talk intelligently about MA plans. Taking certification makes you an expert? How about having hundreds if not thousands of MA customers on the books, along with an equal number of MedSupp customers over a couple of decades? To me that's someone who can now claim expert status. Finally, from other videos I've seen him do he claims he got into the Medicare field in the late 2000's after migrating from FE. Before that he was in law enforcement. Now he claims to having been in this market for over 25 years. I know it's a small thing, but he's proven with that alone that he's not above misrepresentation. I'd love to go toe to toe with him in front of someone turning 65 looking for real, honest advice. I don't know him as well as some of you seem to, but to me all turds like this should be flushed.
What does bother me is that someone holding themselves out there as an expert would put out such a biased video. He slams all MA plans as rotten, untrustworthy, guilty of using misleading sales and marketing practices, and ripping off the government. He used to not sell MA plans at all, but now he admits to it being at least 10% of his business. Does he not care about that 10%? He also claims that he only takes certification so that he can talk intelligently about MA plans. Taking certification makes you an expert? How about having hundreds if not thousands of MA customers on the books, along with an equal number of MedSupp customers over a couple of decades? To me that's someone who can now claim expert status. Finally, from other videos I've seen him do he claims he got into the Medicare field in the late 2000's after migrating from FE. Before that he was in law enforcement. Now he claims to having been in this market for over 25 years. I know it's a small thing, but he's proven with that alone that he's not above misrepresentation. I'd love to go toe to toe with him in front of someone turning 65 looking for real, honest advice. I don't know him as well as some of you seem to, but to me all turds like this should be flushed.
- 29,564
CW's a compulsive liar. He just can't help himself.
Joel T
Expert
Hi
Some background info
I live in Palm Beach cty Fl the last 7 years before that east side of Cleveland Ohio. The only hospital system medical Mutual had in network was the Cleveland Clinic.
My 60 bday present was a cancer diagnosis. My treatment was a 10 hr surgery and after treatment being told it was a resistant type and I was closely monitored.
I became very close with my team that treated me and I was nominated to be on the patient advisory council (12 patients) wherein I had a picture badge just like the Drs & employees and once a month we met with the hospitals top mgmt CEO and down discussing how to make the patient experience better.
Most of my Drs trained at Anderson. Drs at the Clinic are employees of the Clinic not in private practice.Big difference. They all did research work.
When you are a patient at Anderson, Mayo, Clinic , John Hopkins (they considered these were the main hospitals)you are treated by a team of Drs that specialize in your disease. This is a big difference vs a private practice Dr. When you are in their facility everything runs 24-7 including labs 82 operating rooms etc.
I went in for my 5 year checkup my Drs were all smiles as my labs were perfect then my surgeon did her usual ultrasound and saw something. They did a needle biopsy and 5 hrs later I got the call it was back as predicted. This time it was in my esophagus near voice box. They said I had a 50-1 odds of losing my voice.
Another 10 hr surgery by a team of 2 special surgeons who do only 12 of these a year. While it was a bumpy road and I went thru a lot trust me when u hear the c word diagnosis its life changing and you should want the best team available.
If u want a eye opener go to the National Cancer Institute website and see where the major treatment centers are.
So now Im here in S Fl selling medsupps mainly.
Btw I am still being watched by my team in Cle with help of some Drs in Weston Clinic.
Sorry for the ling windedness
Some background info
I live in Palm Beach cty Fl the last 7 years before that east side of Cleveland Ohio. The only hospital system medical Mutual had in network was the Cleveland Clinic.
My 60 bday present was a cancer diagnosis. My treatment was a 10 hr surgery and after treatment being told it was a resistant type and I was closely monitored.
I became very close with my team that treated me and I was nominated to be on the patient advisory council (12 patients) wherein I had a picture badge just like the Drs & employees and once a month we met with the hospitals top mgmt CEO and down discussing how to make the patient experience better.
Most of my Drs trained at Anderson. Drs at the Clinic are employees of the Clinic not in private practice.Big difference. They all did research work.
When you are a patient at Anderson, Mayo, Clinic , John Hopkins (they considered these were the main hospitals)you are treated by a team of Drs that specialize in your disease. This is a big difference vs a private practice Dr. When you are in their facility everything runs 24-7 including labs 82 operating rooms etc.
I went in for my 5 year checkup my Drs were all smiles as my labs were perfect then my surgeon did her usual ultrasound and saw something. They did a needle biopsy and 5 hrs later I got the call it was back as predicted. This time it was in my esophagus near voice box. They said I had a 50-1 odds of losing my voice.
Another 10 hr surgery by a team of 2 special surgeons who do only 12 of these a year. While it was a bumpy road and I went thru a lot trust me when u hear the c word diagnosis its life changing and you should want the best team available.
If u want a eye opener go to the National Cancer Institute website and see where the major treatment centers are.
So now Im here in S Fl selling medsupps mainly.
Btw I am still being watched by my team in Cle with help of some Drs in Weston Clinic.
Sorry for the ling windedness
Yes, I can confirm that he was in the FE market before Med Supps. I can also confirm that he never wrote the first policy with the few contracts that he had with me.
most likely just self-insure
I have come across a few people, that are not even a 1/10 of his net worth, and they have said they just self insure. They don't want to deal with the bureaucracy, monthly bills etc...
writing a check is just easier sometimes.
That guy is broke as hell and probably has a negative net worth after you subtract the loans from Deutsche Bank. After the IRS nails the family for the back taxes they owe related to the tax fraud the whole gang will be in debt to us. I doubt we will get paid back.
Deutsche Bank Resume:
Tax evasion
Espionage scandal
Black Planet Award
April 2015 Libor scandal
Role in 2007–2008 financial crisis
2015 sanctions violations
Dakota Access Pipeline
2017 money-laundering fine
Relationship with Donald Trump
Relationship with Jeffrey Epstein
Criminal cartel charges in Australia
Alleged involvement in Danske Bank money-laundering scandal
Improper handling of ADRs investigation
Malaysian 1MDB fund
You're an ***.
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