patrick.net

The definition of Medicare Advantage or more commonly Disability is the willingness to be treated like a laboratory animal with multiple experimental drugs in exchange for a $800 check in the mail each month.

Medicare Advantage programs are managed care insurance plans. Patients pay little or no premium each month and must use the plan providers for services. This means long waits for appointments, limited options for providers and pre-authorizations for everything.

The Govt pays plans according to a very complicated calculation - but essentially, the sicker that patients are, the more the government pays. Plans have figured out how to maximize their billings and make shitloads of money by lying about their patients' acuities.

The programs do not pay their patients to participate in their plans, nor do they use experimental drugs. And that's not what the article is about.

Now I'm waiting for someone to blame Obama.

Why he only signed it?

CaptainShuddup says

Why he only signed it?

I'm not high, Cap'n. Please do try again.

CaptainShuddup says

Why he only signed it?

Obama signed the Balanced Budget Act of 1997? Pray tell how did that happen captain? I thought he was ambulance chasing in Chicago in 1997. The things I learn from the captain are always amazing. Bullshit, but amazing bullshit.

APOCALYPSEFUCKisShostikovitch says

elliemae says

But billions of tax dollars are misspent every year through billing errors linked to a payment tool called a “risk score,”

Why do you hate innovation?

This is classic. Is everyone aware America spends twice as much as the rest of the world for the lowest quality of heathcare?

This Medicare Advantage abuse is just one example.

Absolutely. The goal is to deny as much care to patients as possible so that the plan owners (investors) can make a shitload of money.

So (from my book, which refers to nursing homes but applies to medical care across the board) - here's how they can make someone appear to require complex care:

The more complicated a patient's needs, the higher the amount that Medicare will pay a nursing home. Nursing homes are able to increase their billings by listing every possible diagnosis for the patient. For example, if a doctor lists "Confusion possibly due to Alzheimer's Dementia" on the hospital History & Physical, a nursing home can list 1) Alzheimer's Disease, 2) Dementia, and 3) Altered Level of Consciousness. Since they are only able to bill for conditions for which the patient is being actively treated, nursing homes can ask their physician to order low doses of medications commonly used to treat those diagnoses. The physicians are usually willing to do so, and are able to increase their billed amounts accordingly. They'll tell the patients/families that they're concerned about the patient, but it can be very difficult for patients to have all of their medications changed in order for the nursing home to increase its revenue.
Those medications have certain side effects, which can mean additional diagnoses of agitation and difficulty sleeping. The patient will also require speech therapy, physical therapy, and occupational therapy. If the reason that the patient was sent to the hospital in the first place was a fall, there are additional potential diagnoses of pain management, constipation (due to the pain medications), dizziness ... and of course, the patient's usual home medications (such as high blood pressure, etc).
It's possible for a patient with virtually nothing wrong with him when he left home to return with 15-20 new diagnoses. When he arrives at home, his primary doctor can discontinue all of the new medications - the patient might go through hell with all of the changes to his system, but the nursing home would have been able to bill at the maximum rates that Medicare will pay.

If you’re insured by both Medicare and another health insurance plan, what happens when you need coverage? The inevitable question of which plan is supposed to pay arises, and if you aren’t careful, you can get yourself into big financial trouble.

If you have Medicare Disadvantage, it means that you have basically assigned your healthcare insurance over to the Plan. Your Medicare A, B & D is now wrapped all into one.

If you are working and you have a primary insurance - and hit 65 years old - your private insurance is primary and Medicare is secondary. It pays those $ that the insurance approves but doesn't pay, as long as Medicare approves the charges.

If you are disabled and covered under your spouses (or parent's) plan, your private insurance is primary and Medicare is secondary. It pays those $ that the insurance approves but doesn't pay, as long as Medicare approves the charges.

If you have Medicare and a secondary insurance, Medicare approves charges and pays 80% of that amount, after co-payments and deductibles. The secondary pays those co-payments and deductibles, unless there's fine print that says it won't.