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Cattledog

(5,919 posts)
Thu Nov 30, 2023, 03:40 PM Nov 2023

Hospitals and doctors are fed up with Medicare Advantage.

Across the country, provider grumbling about claim denials and onerous preapproval requirements by Advantage plans is crescendoing. Some hospitals and physician practices are so fed up they’re refusing to accept the plans — even big ones like those offered by United Healthcare and Humana.

“The insurance companies running the Medicare Advantage plans are pushing physicians and hospitals to the edge,” said Chip Kahn, president and CEO of the Federation of American Hospitals, which represents the for-profit hospital sector.

Last week, the industry’s largest lobbying group, the American Hospital Association, fired off a letter to the Centers for Medicare and Medicaid Services warning that some insurers seem intent on circumventing new rules put in place by the Biden administration aimed at reining in some prior authorization and claim denials.

https://www.washingtonpost.com/politics/2023/11/29/theres-growing-friction-over-prior-approval/

48 replies = new reply since forum marked as read
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Hospitals and doctors are fed up with Medicare Advantage. (Original Post) Cattledog Nov 2023 OP
Limiting the already limited choices for Advantage patients dalton99a Nov 2023 #1
i'm sick to death with the robo calls orleans Nov 2023 #2
I've never listened to them long enough for an introduction Warpy Nov 2023 #8
Now they are trying to suck people in montanacowboy Nov 2023 #3
This message was self-deleted by its author dalton99a Nov 2023 #5
Yes XanaDUer2 Nov 2023 #7
It varies with your plan DownriverDem Nov 2023 #10
Thank you XanaDUer2 Nov 2023 #13
Mine did several years Rebl2 Dec 2023 #42
Made the Change NowISeetheLight Nov 2023 #4
My traditional Medicare starts at midnight nt XanaDUer2 Nov 2023 #6
Same for my dh. ARPad95 Nov 2023 #17
What is dh? XanaDUer2 Nov 2023 #18
DH is dear (or damn if it applies) husband. ARPad95 Nov 2023 #19
I became disabled. Nt XanaDUer2 Nov 2023 #20
I learned something new... ARPad95 Nov 2023 #23
Yes, I'm coming off ACA XanaDUer2 Nov 2023 #24
Thank goodness for OC! ARPad95 Nov 2023 #36
True and Rebl2 Dec 2023 #44
I always thought "DH" stood for "divorced husband". 🤷‍♂️ madinmaryland Nov 2023 #21
That works, too. ARPad95 Nov 2023 #22
thanks for posting Hamlette Nov 2023 #9
It is a problem. I saw it with my mom's coverage. yardwork Nov 2023 #11
Oh come on folks, they are just trying to make a buck... Chainfire Nov 2023 #12
Medicare DISadvantage XanaDUer2 Nov 2023 #14
I am apparently the only person here PoindexterOglethorpe Nov 2023 #15
Do you have a serious illness? Emile Nov 2023 #16
You have not had a serious illness. EOM Scottie Mom Nov 2023 #25
You have not had a serious illness. EOM Scottie Mom Nov 2023 #26
You have not had a serious illness. EOM Scottie Mom Nov 2023 #27
And I am the second person here that is MOMFUDSKI Nov 2023 #29
I'll share my experience likesmountains 52 Nov 2023 #30
No you are not Ferrets are Cool Nov 2023 #31
Medigap zipplewrath Nov 2023 #35
I am also sick of the robo calls LetMyPeopleVote Nov 2023 #28
I feel like I am being stalked by Humana nevergiveup Nov 2023 #32
If you have not had any business relationship with them for 90 days, they may be violating the TCPA. Read this: Wonder Why Nov 2023 #37
I am checking this out.....thanks so much!!!!!! nevergiveup Dec 2023 #40
https://www.fcc.gov/sites/default/files/tcpa-rules.pdf Wonder Why Dec 2023 #41
Thanks!!!!!!!!!!!! nevergiveup Dec 2023 #46
The could effectively end it tomorrow. edhopper Nov 2023 #33
+1 leftstreet Nov 2023 #39
My big complaint is that it's sold as Medicare Part C, which leads people to believe likesmountains 52 Nov 2023 #34
The Medicare Advantage Trap: keithbvadu2 Nov 2023 #38
+1. A must read. dalton99a Dec 2023 #43
Kick XanaDUer2 Dec 2023 #45
Kick nt XanaDUer2 Dec 2023 #47
Kick nt XanaDUer2 Dec 2023 #48

dalton99a

(81,656 posts)
1. Limiting the already limited choices for Advantage patients
Thu Nov 30, 2023, 03:46 PM
Nov 2023
https://archive.ph/wxr4M

Baptist Health in Louisville, for example, has threatened that all of its nine hospitals, along with its clinics and physician groups, will cut ties with Advantage plans offered by UnitedHealthcare and WellCare Health Plans Inc. beginning in January unless they can come to terms.

The plans “routinely deny or delay approval or payment for medical care recommended by your physician,” the system wrote in a message to patients posted on its website.

The system’s medical group, with nearly 1,500 physicians and other providers, left Humana’s network in September.

And in San Diego, more than 30,000 people are looking for new doctors after two large medical groups affiliated with Scripps Health said they would no longer contract with any Medicare Advantage insurers. Revenue “is not sufficient to cover the cost of patient care we provide,” they said in a statement.

...

orleans

(34,086 posts)
2. i'm sick to death with the robo calls
Thu Nov 30, 2023, 03:49 PM
Nov 2023

i've gotten tons from a machine by the name of "eliza"

(fuck off "eliza"!)

Warpy

(111,397 posts)
8. I've never listened to them long enough for an introduction
Thu Nov 30, 2023, 06:22 PM
Nov 2023

I hear that "blip" sound that indicates "I am a fucking robot" and hang right up. If some live person doesn't say "hello" right back at me when I pick up, that call is over. I don't care what they're selling, the phone is a service I pay for and I"m not paying to be advertised to death.

Online mail has done a decent job of getting rid of the worst spammers. I don't know why phone spammers can't be dealt with accordingly.

Shoot, whenever it gets bad, I unplug/turn off the phone. There have been times the damned thing has been off for a couple of weeks. The peace has been wonderful.

Response to montanacowboy (Reply #3)

XanaDUer2

(10,780 posts)
7. Yes
Thu Nov 30, 2023, 06:16 PM
Nov 2023

I'd love to know how much the monthly allowance is for for approved groceries. How does that work?

DownriverDem

(6,232 posts)
10. It varies with your plan
Thu Nov 30, 2023, 06:31 PM
Nov 2023

It's for vitamins, dental products, pain relievers, lots of other care products & some food. I've see anywhere from $125 to $200 per quarter.

XanaDUer2

(10,780 posts)
13. Thank you
Thu Nov 30, 2023, 06:40 PM
Nov 2023

I may look into it, but two of my drs told me to stick with traditional Medicare. Which starts tomorrow

Rebl2

(13,579 posts)
42. Mine did several years
Fri Dec 1, 2023, 09:34 PM
Dec 2023

ago because she knew they likely would not cover some medication I take for rheumatoid arthritis. She seemed up to date on insurance because she has many older patients.

NowISeetheLight

(3,943 posts)
4. Made the Change
Thu Nov 30, 2023, 04:29 PM
Nov 2023

I dumped my UHC policy and switched back to regular Medicare last week. I figure the 80/20 isn't bad when I have full VA available. As long as I notify them within 72 hours they'll pay first and I won't have a bill.

When I called UHC to end my MA policy it was like trying to cancel cable. They passed me around a bit and really tried to get me to stay.

ARPad95

(1,671 posts)
19. DH is dear (or damn if it applies) husband.
Thu Nov 30, 2023, 08:12 PM
Nov 2023

Why did it take 2 years to get Medicare? My dh applied 2 months ago ahead of his 65th in December and got his card a couple of weeks ago.

ARPad95

(1,671 posts)
23. I learned something new...
Thu Nov 30, 2023, 08:46 PM
Nov 2023
https://www.medicare.gov/basics/get-started-with-medicare/before-65

If you’re getting Social Security disability benefits, you’ll get Medicare automatically after getting disability benefits for 24 months.


XanaDUer2

(10,780 posts)
24. Yes, I'm coming off ACA
Thu Nov 30, 2023, 08:53 PM
Nov 2023

I would have had no insurance for 6 months if not for obamacare. It was free to me

Rebl2

(13,579 posts)
44. True and
Fri Dec 1, 2023, 09:42 PM
Dec 2023

You can choose part A only, which I did when I was twenty two yo.-back in late ‘70’s. My parents were able to keep me on their insurance as long as I lived with them. My dad worked at an insurance company and he saw no need for me to get part B at that time. I did get it when I turned 65.

Hamlette

(15,412 posts)
9. thanks for posting
Thu Nov 30, 2023, 06:27 PM
Nov 2023

my husband fell for Medicare Advantage years ago when he signed up. I did not. so I'm happy to forward this to him to point out that . . .I was right AGAIN.

yardwork

(61,729 posts)
11. It is a problem. I saw it with my mom's coverage.
Thu Nov 30, 2023, 06:39 PM
Nov 2023

My mom had Aetna managed care. She had many health problems, and was hospitalized a few years before she passed away. Her health had declined badly, she was in kidney failure, dehydrated, etc. She had a surgical procedure.

She needed a few weeks of rehab after hospitalization before returning to her independent living apartment. Her doctors warned me that Aetna would never approve it.

I fought and fought to get her a few weeks of rehab. Her doctors fought and fought. Aetna declined it over and over, wouldn't return calls, etc. Finally, I gave a check to the rehab center to pay for her care out of pocket, I was that desperate. The day of her hospital discharge Aetna finally relented.

After mom passed last year, I saw how many claims Aetna declined. The hospitals, providers, and hospice group are still trying to get reimbursed. It's ridiculous.

Chainfire

(17,671 posts)
12. Oh come on folks, they are just trying to make a buck...
Thu Nov 30, 2023, 06:39 PM
Nov 2023

We need a sane health care system like other civilized nations have. We don't demand it, so we don't get it. There is no use crying about allowing ourselves to be taken advantage of.

PoindexterOglethorpe

(25,919 posts)
15. I am apparently the only person here
Thu Nov 30, 2023, 07:40 PM
Nov 2023

who has never had a problem with her Advantage Plan.

What am I doing wrong?

likesmountains 52

(4,100 posts)
30. I'll share my experience
Thu Nov 30, 2023, 09:10 PM
Nov 2023

I had a Medicare Advantage Plan for 2 years and loved it. Dental care, vision care, $50 to spend on OTC stuff every 4 months, gift cards for having a physical and getting a mammogram. But, in my smallish town we were very short of specialists and I would be out of plan for most care if I developed any health problems. When one of my siblings suddenly fell ill and died 13 days later of lung cancer, i realized that I needed a better spectrum of providers. I wouldn't try to talk anyone out of their advantage plan if they are happy and healthy, but just know that if you get sick, you might be hung out to dry.

Ferrets are Cool

(21,111 posts)
31. No you are not
Thu Nov 30, 2023, 09:17 PM
Nov 2023

Wifeys cancer medical bills have totalled over one million dollars. We have had to pay about 17k of that total. Without Advantage, we would either be bankrupt or she would be dead from a lack of coverage.

zipplewrath

(16,646 posts)
35. Medigap
Thu Nov 30, 2023, 09:58 PM
Nov 2023

"Regular" medicare really needs medigap insurance like you suggest. Otherwise, the 20% part can really bury someone. The flip side is that under Advantage plans, you can be restricted from the specialists and procedures you may need. IF you can afford medigap insurance, that's the way to go. But many people don't understand that medicare isn't "free" by any stretch for most people. Medigap is just another burden that is a hardship for many people.

If you don't experience serious chronic health issues, Advantage plans appear to be a really good deal. But if you develop serious, and expensive, health issues, they can quickly become a very serious problem.

nevergiveup

(4,768 posts)
32. I feel like I am being stalked by Humana
Thu Nov 30, 2023, 09:39 PM
Nov 2023

I keep getting phone calls and mail from them and I can't go on either the computer or television without being blasted by one of their ads. At this point I consider all of it an invasion of my privacy. My hope at this time is that Elon Musk will buy the company because I know if he does they will go belly up in a couple of years.

Wonder Why

(3,290 posts)
37. If you have not had any business relationship with them for 90 days, they may be violating the TCPA. Read this:
Thu Nov 30, 2023, 10:37 PM
Nov 2023

[link:https://tax.thomsonreuters.com/blog/court-rules-that-health-plans-informational-phone-calls-may-have-violated-telephone-consumer-protection-act/|]

I collected $1500 from our utility for making 3 calls to my wife. Never had to go to court but it can be an easy win if you document, document, document.

edhopper

(33,646 posts)
33. The could effectively end it tomorrow.
Thu Nov 30, 2023, 09:47 PM
Nov 2023

They could also bring about universal health care if they so chose.

likesmountains 52

(4,100 posts)
34. My big complaint is that it's sold as Medicare Part C, which leads people to believe
Thu Nov 30, 2023, 09:51 PM
Nov 2023

that it is part of Medicare. I got it 2 years ago by default when my supplemental plan kind of morphed into advantage. People are not properly informed that when you sign up for 'advantage" you are giving away your regular medicare. It is not an adjunct, it is a totally separate policy.

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