[golfing eagles]

Originally Posted by Joe C.

There's a simple fix for Medicare fraud.
1st offense - $1million fine.
2nd offense - $5million fine and 5 years prison
3rd offense - Seizure of all assets and death penalty.

Or even simpler: Yank licenses and prohibit payments from Medicare

[Rainger99]

Originally Posted by nancyre

BTW there is a BIG difference between a Medicare Advantage HMO & a PPO.

What is the difference??

[Rich42]

You can say what you want, but I have had United’s Advantage plan (paid for by the company I retired from 20 yrs ago) and NEVER had any kind of acceptance or payment problem. A recent hospital stay resulted in a bill for $105,000. I paid $75!

[Pat2015]

Originally Posted by Karmanng

ALOT of these plans are going to go away and many hospitals are not taking these plans either...........traditional is the only way to go for sure........at least i know they are not going to change my drs on me when they feel like it !!! That happened many times to my folks.........

The Medicare Advantage plans are not going to go away and all of the hospitals in local TV area accept them. Not sure what the basis is for either comment?

[Marine1974]

Originally Posted by retiredguy123

Medicare Advantage may be a failed experiment, but so is Traditional Medicare. Medicare fraud is rampant. My mother spent her last 4 months in the hospital or various nursing homes. One medical doctor, who my mother never hired, followed her everywhere she went and billed Medicare for an office visit every day, 7 days per week. She was never hired, and never prescribed any medical treatment. Apparently, she posed as a hospital doctor and got my mother's SSN from her chart. Every day, she would make the rounds visiting her many "patients" in nursing homes and hospitals. Medicare has no checks and balances to determine if a provider was ever even hired by the patient. If they get a bill, they just pay it. At least Medicare Advantage providers have a profit motive to reduce fraud.

The only way to make the system more efficient is to require patients to have "skin in the game" by requiring all patients to pay a copay based on a percentage of the treatment. They need to eliminate free treatments where the patient has no incentive to reduce the cost.

What is a Medicare Provider Number (MPN)?

A Medicare/Medicaid Provider Number (MPN) verifies that a provider has been Medicare certified and establishes the type of care the provider can perform. This identifier is a six-digit number. The first two digits specify the state in which the provider is located, and the last four digits indicate the type of facility. For ambulatory surgery centers, the MPN is 10 digits — with the first two digits representing the state where the surgery center is located.

[GoRedSox!]

The biggest single issue, in my opinion, of Traditional Medicare, is that there is an unlimited co-insurance out-of-pocket expense. In other words, there is no cap on the 20% co-insurance. In the old days when medical treatment was not that expensive, this was not a deal breaker for many. And in the old days, there was no Medicare Advantage. But today, 20% of expensive treatment can quickly add up to a lot. So it seems to me that the two options are Traditional Medicare with a supplemental plan, and Medicare Advantage. The supplemental plans are good, but you could be looking at an additional $3,000 or more in premiums each year, depending on which plan you choose. Medicare Advantage can be the most practical choice for many, and as we see from the stats, the majority of Medicare enrollees have chosen Medicare Advantage. Most plans provide at least some extras that Medicare does not, and most plans have 0 additional premium. They are not perfect, but nothing is. I try not to let perfect be the enemy of good.

[JMintzer]

Originally Posted by La lamy

I've never heard of medicare advantage patient being delayed or denied care. I've seen a lot of lives saved through quick emergency response or months of various treatments to fight cancer successfully. Does the OP have an agenda for spreading this 'info'?

As someone (from a provider's prospective) who has dealt with regular Medicare and all of the Medicare "Advantage" type plans, I can tell you from experience, you couldn't be more wrong...

We've had patients denied care on countless occasions. Those "lives saved" were not saved because someone had an Advantage Plan..

Do you have an agenda for spreading that (incorrect) information?

[JMintzer]

Originally Posted by golfing eagles

Absolutely, positively 100% agree. The OP is nonsense, as is the "list" of "denials" a few posts above.

Do insurance companies occasionally deny requests for certain tests, treatments, hospitals or specialists---you bet they do. Advantage plans do, Medicare supplement plans do, private insurance does. ALL insurance plans have a set of policies and approved services. Most denials are simply because the service was not "coded" properly, others because the service might be new or considered experimental. HMOs and PPOs have a panel of approved physicians that are agreed upon by the insured when they choose that plan---it is the patient's decision. You need approval to go "out of network" or undergo a procedure that is not on the approved list. However, even with those restrictions, 99% of the time one phone call from your physician to the medical director of the insurance plan will get you approval. But that request must be medically necessary---whining that you want hospital A or physician B because your cousin's barber liked them won't do, nor should it.

Can one go on the internet and harvest a bunch of medical "horror stories"??? In a country of 330 million, no problem, since those who feel "wronged" are the first and loudest to complain. I can also find legal horror stories, automotive horror stories, daycare horror stories, and ditch digger horror stories. If someone is looking for 100% perfection in any system, might I suggest the planet Utopia?

Do you want to glean populist support? Just claim that the big, bad CEOs are making a fortune by cheating, conniving, deceiving and exploiting their workers, or the taxpayer, or the government. Readers will eat that crap up. The same readers that will pay thousands to see some guys kick a ball around a field or hear some rap crap guy "sing".

I don't know if the OP has an "agenda", but just add my wife and I to the millions that chose an advantage plan and are happy. And as many of you know I am familiar with medical insurance.

Doc,

Like you, I was in practice (I still am, albeit part time) for almost 40 years...

But I'm going to have to disagree with you on this one. If it were a simple "coding error", then the non-advantage plans would also deny the care (which they don't).

We call to get pre-authorization all of the time. They pre-authorize the care, then they deny payment, stating the pre-authorization was never actually a promise to pay.

Now, granted, we've also occasionally had that happen with commercial insurance companies, but it much, much more rare...

[JMintzer]

Originally Posted by LoisR

Nonsense. Just have the patient sign a doctor's visitation statement.

I have no idea that those words mean...

[JMintzer]

Originally Posted by golfing eagles

Please, please, please make ME the "someone" in power as appointed dictator. I'll fix it in under a year. Of course, I'd also have to disband Congress, rewrite some laws, possibly including the constitution, kill all lobbyists and execute those who propagate ridiculous tripe online. Probably not going to happen

Can I be in charge of "killing all of the lobbyists"? I'd even give them a running start...

[retiredguy123]

Originally Posted by Marine1974

What is a Medicare Provider Number (MPN)?

A Medicare/Medicaid Provider Number (MPN) verifies that a provider has been Medicare certified and establishes the type of care the provider can perform. This identifier is a six-digit number. The first two digits specify the state in which the provider is located, and the last four digits indicate the type of facility. For ambulatory surgery centers, the MPN is 10 digits — with the first two digits representing the state where the surgery center is located.

I'm confused. I never said anything about a Medicare provider number.

[JMintzer]

Originally Posted by MSGirl

Traditional Medicare doesn’t cover everything either. And there are drs who won’t accept any Medicare. Fortunately in The Villages drs can’t survive without Medicare

You post has noting to do with the pluses and minuses of Traditional MC vs MC Advantage plans...

[JMintzer]

Originally Posted by Sandy and Ed

Interesting. I had a lung resection due to cancer. Had follow-up treatments with proton therapy (SBRT) four separate times over the years - latest this past March at Moffitt. Aetna Medicare Advantage paid for it.

I'm glad you received the care you needed. But one anecdotal case does not a trend make...

[Lyarham]

Originally Posted by Dusty_Star

Some say that Medicare Advantage is a failed experiment. Patients get delayed & denied care, the taxpayers are paying mightily for the winners: the insurance company executives. They also say it should be discontinued or dramatically reformed.

MA was sold heavily to Congress by insurance company lobbyists on the basis that it would save money over traditional Medicare.

Is Medicare Advantage a Failed Experiment? Experts Debate - MedCity News

Our advantage plans are great

[JMintzer]

Originally Posted by golfing eagles

Or even simpler: Yank licenses and prohibit payments from Medicare

I've been investigated by Medicare 4 times. The first time, I owed them about $114.00..

The 2nd time, THEY owed ME about 95.00...

The 3rd time, I owed them about about $34.00. For a grand total of about $50... All of them were simple coding errors...

How many thousands of dollars did the spend to recoup $50?

The last investigation?

They accused me of treating a dead person.

No, I may hav nodded off a time or two in Med school, but I'm pretty sure I was awake during the "How to tell if your patient is ALIVE" lecture!

Turns out, I did a wound care consult on a patient during my lunch hour. Later that evening, around 8-9 pm, the patient coded and died...

I had to go to medical records, dig up the chart and copy the entire day's progress notes, including the vital signs taken in the am, lunch time, my consult, early evening vital signs , as well as the "code blue" event...

I sent it all to Medicare and received a very formal letter that simply said, "Never mind"... No apology, "Oops on our part, sorry for the stress we put you thru..."

It was kinda' like getting a threatening letter from the IRS, when the error was on their part. Not good for the heart!