Well care is horrible

[wehotex]

I'm in Texas. I have diabetes type 2 but all my A1C numbers have been great. You think perhaps that's why Wellcare doesn't require any check ups whatsoever? I'm 66 and have never been checked for anything except my diabetes about 10 years ago and that was before I had health insurance. (paid out of pocket). I'm sorry I rant but when I see the royal treatment my wife gets it pisses me off that my company "hides in the shadows"-so to spreak about my health. You guys are the experts. Shouldn't I have had some type of check up by now?

I don’t think that Wellmed customers all necessarily go often to see their doctors. I don’t know if Wellmed innovated this or not, but local lore seems to tout it. In the 90s, WM invested a lot in disease management to control chronic conditions.
Then, it used something called “RAP” scores to bilk more $ from Medicare. It was and is getting more $ to care for these supposedly chronically ill patients.
No other medical group has even come close to managing these conditions as well and even offering heavily discounted drugs for its members who qualify.
To qualify, they don’t even need to be dead azz broke like so many programs. WM even has a department that will renew and qualify its members for Medicaid as well.
Love it or hate it, it cannot be ignored.
Are you yourself an agent?

 

[Chazm]

They have WellMed calling her for something at least once a month. Bone mass, bloodworm, breast exam, her feet, all kinds of things. So I guess I'm to assume that Cigna does not ask for these exams and WellMed does these for free? Interesting.....

Asking for exams and giving them for free are not the same thing. Cigna most likely doesn’t give anything extra for “free” that WellCare doesn’t.

if you’re not happy, move to Cigna. You have until 3/31. Problem solved.

 

[David Dierlam]

I think I'll do that. When you get into your 60's all kinds of things can go wrong.

 

[somarco]

They have WellMed calling her for something at least once a month. Bone mass, bloodworm, breast exam, her feet, all kinds of things. So I guess I'm to assume that Cigna does not ask for these exams and WellMed does these for free? Interesting.....

WellMed is owned by OptumCare, a subsidiary of UHC . . . one of the largest repositories of health care data in the country

Many people don't know, or don't care, who owns their provider.

Raise your hand if you know who OptumCare is. Well, if you haven’t raised your hand yet, get ready to. OptumCare, a part of the Optum subsidiary of UnitedHealth Group (UHG), provides data driven, integrated direct-to-patient care including physicians, home health, urgent care and surgical care totaling over $15 billion of revenue in 2016. Said another way – OptumCare is in the top 10 largest health care systems in the United States – larger than the Mayo Clinic, the Cleveland Clinic or the University of Pittsburgh Medical Center. Analysts believe this business could eventually generate over $150 billion of revenue and could quickly become the largest system in the US. That is a trajectory that would make Sam Walton and Jeff Bezos proud.

On the payer side of UnitedHealth Group, it collects premiums and invests the money before it pays it out in claims. But it also gets a benefit from Optum – its productivity platform. Increasingly, UnitedHealth Care is reimbursing OptumHealth for medical services rather than other hospitals or physicians – saving money on efficiencies while keeping it in house. It also leverages its expertise from its data and analytics business by using machine learning and artificial intelligence (AI) to save on costs while getting a better view of patients. UHG also sells end-to-end payment management systems to customers while leveraging the benefits within OptumCare. This gives UHG a tremendous platform to grow profitably while continuing to reduce the cost of care.

[EXTERNAL LINK] - Optumcare: The Biggest Health Care System You Have Never Heard Of

When it comes to health care, saving money means . . . saving money for the carrier (not you), and, in this case, saving money for the clinic (which makes it more profitable).

Who loses in this equation.

Many times it is the patient who pays more for their care (more copays, higher OOP) in exchange for healthcare that is based on accounting principles over outcome. In other words, "bean counter medicine" where the care the patient receives is based on cost (to the carrier) and nothing else.

In this system, your doctor works for the insurance carrier, not for you.