CMS policy is the proof.

-Laelth

They have 450 doctors and told all pcp’s to go home. They are using video where possible.

of sheltering in place. His receptionist said there was no reason to cancel as the doctor will do the appointment by phone.

I agreed but now that I think about it, a telephone interview can't take my blood pressure, temperature, heart rate, etc. And I'll probably be billed at the usually rate.

covers it too:

https://www.medicare.gov/coverage/telehealth

a damn pandemic of all things.

Have your CEO call me, I have a few choice words for him.

is down right criminal.

The Plan gets paid for a telemedicine encounter just like an office or any other encounter through their monthly amount from CMS. The Plan is just looking for diagnoses to get a special bonus -- the Risk Adjustment. That's immoral, unethical at best in this case, putting patients and doctors at risk.

I am generally for Medicare Advantage Plans and have taken a lot of heat here for that. But this is wrong.

This is not about free care that the Plan is not getting reimbursed by the government for. This plan is putting patients and providers at risk.

Can you give me the name of the plan?

We have a lot of people to care for and you seem hell-bent on taking up our time so we can educate you.

Your statement "The Plan gets paid for a telemedicine encounter just like an office or any other encounter through their monthly amount from CMS."

is factually inaccurate, as I explained.

And BTW, it's not the plan that requires people to come in in person, please read what I wrote. It's CMS that has structured it that way. The plan I work for has actually called off efforts to get people to come in for a face-to-face visits, as soon as the pandemic began. Our telehealth visits have skyrocketed and we're happy about that. We're just not getting reimbursed for the expense of caring for any DIAGNOSIS that's coded during such a telehealth visit. Not just for the visit, for the whole diagnosis! If a person has COPD, HIV, heart disease, diabetes, you name it, if it's coded on a telehealth visit, to CMS it doesn't exist, and isn't reflected in the premium.

Your outrage should be directed at CMS. People just think that all health insurance plans are evil, and it's often true, but not always.

Last edited Fri Mar 27, 2020, 09:35 AM - Edit history (1)

in that, because I used to recommend them to people in areas where they have plans, saying they were Non-Profit and all that.

I fully understand how Risk Adjustments work, believe me. And I still think what _ is doing is immoral and unethical, at best, even if best for their bottom line.

or to attempt to do so?