One of the things I’ve always found most fascinating about news coverage and policymaker attention to health insurers is how little focus is placed on what these companies say to their investors.
"Unlike their marketplace and employer-based plans, insurers can’t negotiate reimbursement rates for Medicaid and Medicare Advantage plans that they manage." So in our experience, they can and they do. Medicare Advantage Anthem pays a family practice visit level 4 $63 even though the Medicare reimbursement is $121.04. This is why we opted out of their Advantage plans- we could not afford to see them.
Even more insane is that the $63 is the total rate, including for dual eligibles (Medicare/Medicaid) so we only got $40.82 for each level four visit. You cannot of course collect copay on dual eligibles.
Well, that's not even up for debate. Medicaid used to pay up to the Medicare rate as a secondary but somewhere around 2017-ish (I don't remember exactly when) they only pay as a secondary UP TO THE MEDICAID rate. So dual eligibles are effectively Medicaid patients. And that is a hard fast rule, no question. OTOH, if your office is unaware that a patient has Medicaid as a secondary and your system spits out a bill because the patient didn't give you a Medicaid card, that is grounds for license removal and criminal charges, even if you didn't collect from them. The mere printing of the bill is a criminal act and they (CMS or Advantage plans acting as judicial proxy) can decide whether or not to prosecute as such.
I've not seen any case of anything being illegal when it comes to abuse of providers. Everyone else (patients and providers) is regulated to the max, at least in the Cleveland market. Definitely not a good place to be a doctor. Even the Board is corrupt, and that's a whole other area of abuses that never get challenged or corrected.
Who gives a toss if the insurers are concerned about profits. Healthcare should all be nonprofit organizations. No one in the Media is seriously talking about the impact of these private insurers when 10,000 or more Americans are dying because Medicare services are being denied or delayed, or even the fact that private insurers cannot match the costs of Traditional Medicare . It is time we give these private conglomerates the boot to their posterior ends. What about patient care, quality care as if the Leadership of these Insurers don’t give a damn about their customers’ lives and the CEO’s explanations or excuses as to why they need to be obscenely compensated on the backs of exploited patients. Enough of this BS. This inertia and lack of will on the part of our elected officials as well as the greedy corruption of price gouging Insurers is a dynamic that must be laid to rest on the dustbin of failed policy that keeps on being rehashed.
I would like to see these Medicare Advantage CEOs and the politicians who don’t represent the interests of the American people first and foremost up on criminal charges of involuntary homicide with heavy jail time for the loss of lives of those of us who pay more than our share of the tax burden.
Good question. Government subsidies assure their profits, no matter how many people die;-)
However, we will soon see the parasite outgrow it's host. And it will resort to sucking the marrow out of the bones of the last few productive people left (unvaccinated;-) as this entire nightmare collapses in on itself.
Why don’t insurance companies realize that they are slowly killing their golden goose? I’m a “provider” and they seem not to care that they are squeezing us to the point of leaving the field or courting cash only patients? We need national healthcare and ins cos will have to find niche & concierge plans like they have in the countries with national healthcare.
Here in New Zealand they must be driving people to absorb the increased costs of private hospital and insurance by FEAR.
As of last week we had a friend hospitalised in the public system diagnosed with liver cancer. Three weeks, no personal care. No clean sheets , no mouth care, no washing, no shaving etc. Plenty of annoying and interruption tests but no results forth coming. All this had to be done by family one who is a very experienced and qualified nurse.
He died. Vaxxed and only in his fifties , fit and working he was gone in under three weeks.
Turbo cancer is an anti-vaccination conspiracy theory alleging that people vaccinated against COVID-19, especially with mRNA vaccines, are suffering f
from a high incidence of fast-developing cancers. Although the idea has been spread by a number of vaccine opponents, including doctors,[2] turbo cancer is not supported by cancer research, and there is no evidence that COVID-19 vaccination causes or worsens cancer.[3][4][5]
"Unlike their marketplace and employer-based plans, insurers can’t negotiate reimbursement rates for Medicaid and Medicare Advantage plans that they manage." So in our experience, they can and they do. Medicare Advantage Anthem pays a family practice visit level 4 $63 even though the Medicare reimbursement is $121.04. This is why we opted out of their Advantage plans- we could not afford to see them.
UHC is around $110 here, although we no longer take them because they refuse to pay for labs.
Even more insane is that the $63 is the total rate, including for dual eligibles (Medicare/Medicaid) so we only got $40.82 for each level four visit. You cannot of course collect copay on dual eligibles.
Well, that's not even up for debate. Medicaid used to pay up to the Medicare rate as a secondary but somewhere around 2017-ish (I don't remember exactly when) they only pay as a secondary UP TO THE MEDICAID rate. So dual eligibles are effectively Medicaid patients. And that is a hard fast rule, no question. OTOH, if your office is unaware that a patient has Medicaid as a secondary and your system spits out a bill because the patient didn't give you a Medicaid card, that is grounds for license removal and criminal charges, even if you didn't collect from them. The mere printing of the bill is a criminal act and they (CMS or Advantage plans acting as judicial proxy) can decide whether or not to prosecute as such.
I've not seen any case of anything being illegal when it comes to abuse of providers. Everyone else (patients and providers) is regulated to the max, at least in the Cleveland market. Definitely not a good place to be a doctor. Even the Board is corrupt, and that's a whole other area of abuses that never get challenged or corrected.
Who gives a toss if the insurers are concerned about profits. Healthcare should all be nonprofit organizations. No one in the Media is seriously talking about the impact of these private insurers when 10,000 or more Americans are dying because Medicare services are being denied or delayed, or even the fact that private insurers cannot match the costs of Traditional Medicare . It is time we give these private conglomerates the boot to their posterior ends. What about patient care, quality care as if the Leadership of these Insurers don’t give a damn about their customers’ lives and the CEO’s explanations or excuses as to why they need to be obscenely compensated on the backs of exploited patients. Enough of this BS. This inertia and lack of will on the part of our elected officials as well as the greedy corruption of price gouging Insurers is a dynamic that must be laid to rest on the dustbin of failed policy that keeps on being rehashed.
I would like to see these Medicare Advantage CEOs and the politicians who don’t represent the interests of the American people first and foremost up on criminal charges of involuntary homicide with heavy jail time for the loss of lives of those of us who pay more than our share of the tax burden.
Thank you for keeping us well informed about the shenanigans that the insurance companies are playing with our health.
Good question. Government subsidies assure their profits, no matter how many people die;-)
However, we will soon see the parasite outgrow it's host. And it will resort to sucking the marrow out of the bones of the last few productive people left (unvaccinated;-) as this entire nightmare collapses in on itself.
Why don’t insurance companies realize that they are slowly killing their golden goose? I’m a “provider” and they seem not to care that they are squeezing us to the point of leaving the field or courting cash only patients? We need national healthcare and ins cos will have to find niche & concierge plans like they have in the countries with national healthcare.
They don’t care. They are getting paid by government to cover their losses.
Boom!
Here in New Zealand they must be driving people to absorb the increased costs of private hospital and insurance by FEAR.
As of last week we had a friend hospitalised in the public system diagnosed with liver cancer. Three weeks, no personal care. No clean sheets , no mouth care, no washing, no shaving etc. Plenty of annoying and interruption tests but no results forth coming. All this had to be done by family one who is a very experienced and qualified nurse.
He died. Vaxxed and only in his fifties , fit and working he was gone in under three weeks.
Turbo cancer
Wikipedia
https://en.wikipedia.org › wiki › Turbo_cancer
Turbo cancer is an anti-vaccination conspiracy theory alleging that people vaccinated against COVID-19, especially with mRNA vaccines, are suffering f
from a high incidence of fast-developing cancers. Although the idea has been spread by a number of vaccine opponents, including doctors,[2] turbo cancer is not supported by cancer research, and there is no evidence that COVID-19 vaccination causes or worsens cancer.[3][4][5]
For Profit healthcare is literally killing us. For the almighty dollar we sacrifice lives