[outlaw]

Originally Posted by golfing eagles

Are you somehow implying that this insurance decision, made by administrators of TVH, is somehow the fault of "the doctors" who provide patient care??? That they must be "greedy" and "uncaring". Get real.
Everyone should realize that TVH is a corporate environment, the physicians are employees, and even the medical directors of the individual centers have almost no input with regards to these decisions.
As far as "bait and switch", "lies", "fraud", and "deceit" goes, this is only true if patients were told they would be grandfathered AFTER the insurance change decision was made, which I doubt. There is no vast conspiracy about insurance decisions. They come up every year, and these decisions are usually made in a matter of weeks. So unless someone was specifically told they could stay in with traditional Medicare and supplement, AS A NEW PATIENT IN JUNE, there is very little basis for calling them liars. Things change, especially in healthcare these days. No one is being "dumped". If you are 65, you can either change you provider out of TVH, or change your insurance. Your choice, you cannot have both. Seems like the general expectation has been that everyone should be able to have their cake and eat it too. Not in the real world, not anymore.

UHC knew long ago they were going to drop the hammer on "grandfathered" patients. I was told in October, when I was considering joining TVH, that I would be grandfathered in once I turned 65, and I would be able to continue with medicare and my supplemental insurance. Then, in January, three months later, my wife gets her "the letter". then, in May, I get "the letter". Quit defending the indefensible.

[2BNTV]

Originally Posted by golfing eagles

Are you somehow implying that this insurance decision, made by administrators of TVH, is somehow the fault of "the doctors" who provide patient care??? That they must be "greedy" and "uncaring". Get real.
Everyone should realize that TVH is a corporate environment, the physicians are employees, and even the medical directors of the individual centers have almost no input with regards to these decisions.
As far as "bait and switch", "lies", "fraud", and "deceit" goes, this is only true if patients were told they would be grandfathered AFTER the insurance change decision was made, which I doubt. There is no vast conspiracy about insurance decisions. They come up every year, and these decisions are usually made in a matter of weeks. So unless someone was specifically told they could stay in with traditional Medicare and supplement, AS A NEW PATIENT IN JUNE, there is very little basis for calling them liars. Things change, especially in healthcare these days. No one is being "dumped". If you are 65, you can either change you provider out of TVH, or change your insurance. Your choice, you cannot have both. Seems like the general expectation has been that everyone should be able to have their cake and eat it too. Not in the real world, not anymore.

I have noticed the big change in the way insurance companies do business over many years. When my friend tells me what he pays for insurance for a family of four in a corporate structured environment, (we worked for the same company). I fondly think of the day when we paid almost nothing, for the same coverage.

I lament TVH doesn't take original Medicare with a supplement, as they say they won't be able to spend the extra time with patients and it's not economically feasible, as they need to make a profit.

Wouldn't it be nice to complain and have it heard, "from our lips to GOD's ears".

As the kids today says, "it is, what it is".

[golfing eagles]

Originally Posted by outlaw

UHC knew long ago they were going to drop the hammer on "grandfathered" patients. I was told in October, when I was considering joining TVH, that I would be grandfathered in once I turned 65, and I would be able to continue with medicare and my supplemental insurance. Then, in January, three months later, my wife gets her "the letter". then, in May, I get "the letter". Quit defending the indefensible.

No, I think it is defensible and I will defend it.

1) How do YOU know what UHC knew and when they knew it???

2) You were told by whom??? COO of TVH??
CEO of UHC??? More than likely it was from someone nowhere near that high on the food chain.

I would agree that once the decision was made, whenever that was, TVH should have informed all its employees not to give out any misinformation and inform the patients ASAP. But not knowing the TRUE timeline, I have no idea whether or not this happened.

[biker1]

I am most definitely not a Medicare expert but I can certainly understand why they are doing what they are doing. As I understand it, and someone correct me if I am wrong, if you enroll in an MA plan then the plan gets up to $18K/year from Medicare plus your $122/month (??) plus what would be the approximate monthly cost of a supplemental plan and then the plan doesn't have to deal with Medicare anymore. They can attempt to "manage" your benefits by restricting the pool of providers. So, if you have minimal health issues, the MA plan can make money since they keep the $18K and monthly charges. Obviously they are also accepting the risk of unhealthy patients since they now "own" all the costs.

Originally Posted by 2BNTV

[/B]



I have noticed the big change in the way insurance companies do business over many years. When my friend tells me what he pays for insurance for a family of four in a corporate structured environment, (we worked for the same company). I fondly think of the day when we paid almost nothing, for the same coverage.

I lament TVH doesn't take original Medicare with a supplement, as they say they won't be able to spend the extra time with patients and it's not economically feasible, as they need to make a profit.

Wouldn't it be nice to complain and have it heard, "from our lips to GOD's ears".

As the kids today says, "it is, what it is".

[CritterLover]

Originally Posted by golfing eagles

No, I think it is defensible and I will defend it.

1) How do YOU know what UHC knew and when they knew it???

2) You were told by whom??? COO of TVH??
CEO of UHC??? More than likely it was from someone nowhere near that high on the food chain.

I would agree that once the decision was made, whenever that was, TVH should have informed all its employees not to give out any misinformation and inform the patients ASAP. But not knowing the TRUE timeline, I have no idea whether or not this happened.

Now, that's using your noodle! Bravo!

[golfing eagles]

Originally Posted by biker1

I am most definitely not a Medicare expert but I can certainly understand why they are doing what they are doing. As I understand it, and someone correct me if I am wrong, if you enroll in an MA plan then the plan gets up to $18K/year from Medicare plus your $122/month (??) plus what would be the approximate monthly cost of a supplemental plan and then the plan doesn't have to deal with Medicare anymore. They can attempt to "manage" your benefits by restricting the pool of providers. So, if you have minimal health issues, the MA plan can make money since they keep the $18K and monthly charges. Obviously they are also accepting the risk of unhealthy patients since they now "own" all the costs.

I'm not sure about the dollar amounts, but your description of how it works is sound. The government, many years ago, realized they could not easily control how many tests and specialty referrals doctors made. So, they developed the concept of "risk sharing". In essence, they pay the insurance company a certain amount per year, and then let them manage utilization. Of course, they had to add safeguards to make sure there was no "cherry-picking" of healthy patients, and also some guards against catastrophic costs.
The problem is that the insurance company now puts obstacles in the way of appropriate care to avoid unnecessary care. The number one cause of unnecessary care is lawyers. The number two cause is weak providers.
The most common "trick" is to deny approval for a test or referral until the physician PERSONALLY speaks to the medical director at the insurer. They know that just the time constraints alone will cause 20-30% of the requests to "disappear". I never had a request denied after speaking to them, but I abhorred the complete waste of time. Yet, I have to believe that this policy saved $$$, otherwise the cost of these "administrators" could not be justified.

[Bogie Shooter]

Originally Posted by RErmer

I was told no doctors would be affected (lose jobs) as a result of this change. My source is someone high in The Viilages Health hierarchy whose name I just can't post.

Originally Posted by outlaw

I heard that TVHC management assured the doctors that if they like their job, they can keep their job...we'll see.

Rumors add so much to a conversation..................

[Happydaz]

Originally Posted by Bogie Shooter

Rumors add so much to a conversation..................

Actually, rumors add a lot to the conversation. For example, many months ago a post was made that 15,000 TVH patients would be getting letters that they had to convert to United Health Care MA plan or leave the practice. This has turned out to be true. Another post I made long before the new Village of Fenney was announced reported possible expansion of the Villages south of 44. The Villages is a large corporation that plays close to the vest on their decisions, but like at any large company, people often leak out the details. It is true that no one knows if these rumors are true when they first appear, but as far as this Marcus Welby healthcare system at TVH goes, they are often proving true. Marcus Welby is kicking grandma to the curb because she doesn't have the right insurance! No wonder some of the doctors have objected and resigned. I worked in healthcare for many years and I can't recall a private practice accepting only one insurance plan. Sure staff HMO's like Kaiser and Harvard Community Health Plan ran their own plans, but they contracted directly with large payors such as corporate healthcare plans offered to employees. Medicare changes constantly. Why it was only three years ago that they were about to do away with the Medicare Advantage plans altogether. They survived, but who knows what the future holds. What TVH has done looks to me like one of the biggest blunders I have ever seen in healthcare.

[bimmertl]

Some history on The Villages Health and how USF took a big hit. Then, the guy who engineered the failed plan gets hired by Morse. Why would anybody hire someone with such a large failure on his resume? You'll find Lowenkrons name on your letter

After USF failure in the Villages, top official finds job there | Tampa Bay Times

So then, Lowenkron sued USF for his salary. Doubt he took a pay cut to come to The Villages. Classy guy!

Ex-USF Physicians Group boss sues USF for $600,000 pay | TBO.com

[mgjim]

Originally Posted by JoMar

I think they take Tricare and will continue to do so.

I've heard this before, but I recently went from Tricare Standard to Tricare for Life and The Villages Health dropped me. I think they accept Tricare Prime and Tricare Standard, but once you switch to Tricare for Life, they no longer accept your insurance plan.

On the plus side, I found a primary care provider at another clinic and I'm perfectly satisfied with my decision. And, Tricare for Life is far superior to anything United Healthcare has to offer.

[graciegirl]

Originally Posted by bimmertl

Some history on The Villages Health and how USF took a big hit. Then, the guy who engineered the failed plan gets hired by Morse. Why would anybody hire someone with such a large failure on his resume? You'll find Lowenkrons name on your letter

After USF failure in the Villages, top official finds job there | Tampa Bay Times

So then, Lowenkron sued USF for his salary. Doubt he took a pay cut to come to The Villages. Classy guy!

Ex-USF Physicians Group boss sues USF for $600,000 pay | TBO.com

I read the links you posted. It says USF pulled out because they didn't make the money they thought they would.

Lowenkron's sued for money that his contract said was his according to your link. That was a year's salary at USF. He must be a smart fellow.

[Mikeod]

Originally Posted by bimmertl

Some history on The Villages Health and how USF took a big hit. Then, the guy who engineered the failed plan gets hired by Morse. Why would anybody hire someone with such a large failure on his resume? You'll find Lowenkrons name on your letter

After USF failure in the Villages, top official finds job there | Tampa Bay Times

So then, Lowenkron sued USF for his salary. Doubt he took a pay cut to come to The Villages. Classy guy!

Ex-USF Physicians Group boss sues USF for $600,000 pay | TBO.com

I think what you're seeing at Villages Health is a continuation of what transpired with Moffitt and USF. Both had a plan that anticipated a certain percentage of their patients being enrolled in a MA plan. When they realized that was not obtainable, they pulled the plug. VHS has the same problem. With the limits on panel size, there is insufficient income to sustain the plan without the annual allowance paid per member. Therefore, the decision was made to make the UHC plan a requirement. Apparently, the whole system was in jeopardy if they didn't.

[zonerboy]

Indeed things do change, and often not for the better. In ancient times when I became a physician, many of the arrangements and relationships so common today would have been considered gross violations of medical ethics. Upon graduation, I took an oath to always put the health needs of my patients first; before personal comfort and convenience, before any financial considerations, and even before the needs of family and spouse. I can recall over the years many a time Thanksgiving or Christmas festivities were interrupted because I was called in to care for someone needing urgent surgery. I was not allowed to know what type of insurance plan they had, or whether they had any insurance coverage at all. I just went in and took care of the situation whatever it might have involved.
So back to the present. As a retired physician I know the difference between good medical care and not so good. Over the past several years I was quite satisfied with the care rendered by my primary care MDs at The Villages Health. But last year when my wife required serious back surgery, I wanted it to be done by the best back surgeon I could find. I did not want my choices to be limited to those having some sort of contractual or network connection to TVH. Because we had original Medicare plus a BC/BS supplement, I was able to choose practically whomever I wanted. So I did. And the operation was a great success.
For this reason we desire to keep our current insurance status and so will be forced to seek new primary care doctors. And I'm not too happy about it. Hoping the whole United Healthcare arrangement goes belly up and the Morse family is stuck with many fancy, new, but empty medical office buildings.

[ColdNoMore]

Originally Posted by zonerboy

Indeed things do change, and often not for the better. In ancient times when I became a physician, many of the arrangements and relationships so common today would have been considered gross violations of medical ethics. Upon graduation, I took an oath to always put the health needs of my patients first; before personal comfort and convenience, before any financial considerations, and even before the needs of family and spouse. I can recall over the years many a time Thanksgiving or Christmas festivities were interrupted because I was called in to care for someone needing urgent surgery. I was not allowed to know what type of insurance plan they had, or whether they had any insurance coverage at all. I just went in and took care of the situation whatever it might have involved.
So back to the present. As a retired physician I know the difference between good medical care and not so good. Over the past several years I was quite satisfied with the care rendered by my primary care MDs at The Villages Health. But last year when my wife required serious back surgery, I wanted it to be done by the best back surgeon I could find. I did not want my choices to be limited to those having some sort of contractual or network connection to TVH. Because we had original Medicare plus a BC/BS supplement, I was able to choose practically whomever I wanted. So I did. And the operation was a great success.
For this reason we desire to keep our current insurance status and so will be forced to seek new primary care doctors. And I'm not too happy about it. Hoping the whole United Healthcare arrangement goes belly up and the Morse family is stuck with many fancy, new, but empty medical office buildings.

An excellent post, made even more compelling by your own personal experience and knowledge.

You seem to have lived the 'Marcus Welby, M.D.' creed...instead of just spouting it.

Good for you.

[RedChariot]

Originally Posted by zonerboy

Indeed things do change, and often not for the better. In ancient times when I became a physician, many of the arrangements and relationships so common today would have been considered gross violations of medical ethics. Upon graduation, I took an oath to always put the health needs of my patients first; before personal comfort and convenience, before any financial considerations, and even before the needs of family and spouse. I can recall over the years many a time Thanksgiving or Christmas festivities were interrupted because I was called in to care for someone needing urgent surgery. I was not allowed to know what type of insurance plan they had, or whether they had any insurance coverage at all. I just went in and took care of the situation whatever it might have involved.
So back to the present. As a retired physician I know the difference between good medical care and not so good. Over the past several years I was quite satisfied with the care rendered by my primary care MDs at The Villages Health. But last year when my wife required serious back surgery, I wanted it to be done by the best back surgeon I could find. I did not want my choices to be limited to those having some sort of contractual or network connection to TVH. Because we had original Medicare plus a BC/BS supplement, I was able to choose practically whomever I wanted. So I did. And the operation was a great success.
For this reason we desire to keep our current insurance status and so will be forced to seek new primary care doctors. And I'm not too happy about it. Hoping the whole United Healthcare arrangement goes belly up and the Morse family is stuck with many fancy, new, but empty medical office buildings.

Thank you for this excellent post. You sound like many of the physicians I worked with over my long career as a Registered Nurse. Many a holiday or weekend I would need to call in the OR for a surgery that could not wait. Snow storms and ice on the road did not matter. That OR team would come. This is the level of dedication I expected from TVH. Dedication to the health care of a senior population. What a foolish old nurse was I. I will begin to search for another doctor. But I know I will not find the likes of you sir.