No shocker here: The first insurer mentioned was Kaiser.[1]
The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne, or a bonus in their paycheck.
Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.
The only major Medicare Advantage insurer that isn't ripping off the government with both hands is Centene.
So, during this open enrollment period, when you see the ads for the various Medicare Advantage insurers, keep in mind that most of them are thieves who would willingly use you to rip off the government.
If you're in a Medicare Advantage plan and you get an Explanation of Benefits that looks fishy, call in a tip to HHS at 1-800-447-8477.
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[1] My belief is that Kaiser pretty much let a close relative of mine die of cancer because the Kaiser oncologist thought that there was nothing to be done, without, as I understand it, bothering to consult anyone else. My suspicion is that treating people costs money and, if a person who is in a Kaiser HMO isn't on Medicare, then their fiscal incentive is to let them die.
But that's my belief. YMMV.
4 comments:
When you go on MC, it pays 80% of what the regs say is the appropriate flat rate (you're in the body shop after all). You're on the hook for the remainder (note that this is 20% of the flat rate NOT whatever the grifters would otherwise soak you for). You can either pay it OR get a MC supplemental plan. The MCS plan come in a number of different extents of coverage and all insurance offering for a given extent of coverage has match gummint reg standard so there is not flimflam in the fine print and weasel wording. The plans have alphabet letters; I have plan F and it pays for everything in the remainder 20%. It costs me about $275/mp/person.
Like MC, MCS is accepted everywhere.
Of course, you don't get the extra goodies like dental, hearing and vision benefits that sometimes come MA plans. But you'll know that you get everything allowed by MC without any weaseling.
I believe that for-profit medicine is an abomination. Non-governmental insurance is statistical gambling, and, at age, when your health begins to shred, gambling against the for-profit house means you lose.
YMMV. My previous "healthcare" provider just noted my aortic stenosis getting worse and worse and did nothing, thanks to strict capitation.
Switching to Kaiser PNW, I had my heart valve replaced promptly with a $600 co-pay. I would have died 5 years ago without that heart valve. As long as they had the hood up, I also got a double bypass. They've been helping me manage my Type 2 diabetes quite well, too, with periodic foot exams.
Based on my experience with the local Kaiser, I will probably choose them as my Medicare provider when I retire. My spouse has been retired for over 10 years and has been quite happy with her experience, too.
Again,YMMV. Anecdote is not a datum.
I've had Medicare since my stroke in 2008, and they've repeatedly tried to sell me a Medicare Advantage plan, but for the premium I wouldn't get anything I don't already have. That might not be true in a state that didn't expand Medicaid under the ACA, but here in California my SSDI doesn't exclude me from Medicaid so when I needed cataract surgery, MediCal paid the 20% that Medicare doesn't pay. My regular doctor and Camarena Health are fine taking what Medicare pays them and my prescriptions are $4 at the Vons pharmacy. If I had more complicated medical needs than I do, perhaps additional insurance would be worth the extra money, which at this point would have to come out of my food budget.
-Doug in Sugar Pine
Remember when during the run up to what became known as Obamacare the squawkers and criers were saying that it would lead up to "death panels". They just wouldn't admit that the private, for profit insurance companies already had them.
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