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Originally Posted by elle123
It's the insurance companies pushing physcian assistants and nurse practitioners. It's also the insurance industry that's absconding with billions. Privatized Advantage Medicare allows for greater fraud. "Private Advantage Medicare plans are paid based on a "risk score" that correlates with a patient's health. To increase profits, some plans or their contractors exaggerate patients' diagnoses, making them appear sicker than they are to receive higher payments from the Centers for Medicare & Medicaid Services (CMS)."
In addition, "some health plans and brokers offer illegal incentives to gain enrollment, which violates regulations designed to protect beneficiaries.
Insurers pay brokers illegal kickbacks to steer beneficiaries toward their specific MA plans, rather than recommending the plan that best suits the beneficiary's needs." That's probably what happened in The Villages and explains why the facility rejected regular Medicare.
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That is why there are so many ICD diagnosis codes on your Explanation of Benefits. It's also interesting to read your medical records- sometimes if you mention something (ex. such as occasional back pain), you might find a diagnosis that would warrant xrays with another practice you may be a patient of, when you may not need them. Interpretation by cross-sharing medical records in the cloud is another interesting occurrence. Underwriting medical exams for insurance must be much easier for denying medical or life insurance these days since everything is out there. XX Denied!