Talk of The Villages Florida

Talk of The Villages Florida (https://www.talkofthevillages.com/forums/)
-   Medical and Health Discussion (https://www.talkofthevillages.com/forums/medical-health-discussion-94/)
-   -   The Villages Health Care Program (https://www.talkofthevillages.com/forums/medical-health-discussion-94/villages-health-care-program-166313/)

golfing eagles 10-15-2015 08:04 AM

Quote:

Originally Posted by outlaw (Post 1129549)
I guess it would have been funnier if I would have posted in Latin.

Way, way, way too early for THAT:a20:

dotti105 10-15-2015 10:50 PM

Golfing Eagles, I appreciate the negative information you have presented on the ACA and it's management by our mega insurance companies.

As I understand it, the US is one of the few developed nations that does not have a single payer system. Are they all wrong? I worked in the bay area with RNs from Canada who would not get US citizenship because they do not want to give up their excellent medial insurance in Canada. Why would that be?

While traveling in Australia, the people we met were all very happy with their universal health care.

No "death committees" in either country. Health care is considered a right in those countries as well as in the many other developed countries who rank above us in quality and outcomes.

I don't understand how that works. If universal health care is such a bad idea, why has it been so successful and well received in so many other nations? And why have we consistently ranked so low in outcomes?

Costs have increased dramatically during my years working as a RN, the pay....not so much. The Hospital corporations are flush with cash, HCA for example, (Governor Rick Scott's former "ATM card") where I worked for the last 10 years has made record profits year after year. Their hospitals are 12 of the top 25 in profits year after year.

Some one is making a lot of $$ on the back of the health care industry, it's healthcare providers, and patients alike.

Please enlighten me? No sarcasm intended. I really want to hear your reasoning for the situation here compared to the other 1st world countries.

I do enjoy your posts and respect your opinions.

golfing eagles 10-16-2015 05:51 AM

Quote:

Originally Posted by dotti105 (Post 1129927)
Golfing Eagles, I appreciate the negative information you have presented on the ACA and it's management by our mega insurance companies.

As I understand it, the US is one of the few developed nations that does not have a single payer system. Are they all wrong? I worked in the bay area with RNs from Canada who would not get US citizenship because they do not want to give up their excellent medial insurance in Canada. Why would that be?

While traveling in Australia, the people we met were all very happy with their universal health care.

No "death committees" in either country. Health care is considered a right in those countries as well as in the many other developed countries who rank above us in quality and outcomes.

I don't understand how that works. If universal health care is such a bad idea, why has it been so successful and well received in so many other nations? And why have we consistently ranked so low in outcomes?

Costs have increased dramatically during my years working as a RN, the
pay....not so much. The Hospital corporations are flush with cash, HCA for example, (Governor Rick Scott's former "ATM card") where I worked for the last 10 years has made record profits year after year. Their hospitals are 12 of the top 25 in profits year after year.

Some one is making a lot of $$ on the back of the health care industry, it's healthcare providers, and patients alike.

Please enlighten me? No sarcasm intended. I really want to hear your reasoning for the situation here compared to the other 1st world countries.

I do enjoy your posts and respect your opinions.

Wow, there's a lot in there, I could write a book! So I'll try to be short and answer point by point---but while I back this with facts, it is still only my opinion and I'm sure others will disagree.

Golfing Eagles, I appreciate the negative information you have presented on the ACA and it's management by our mega insurance companies.

Actually, I believe the only negative part (that I mentioned) was the cost and how it was misrepresented as well as the lack of scope in addressing the true problems in healthcare

As I understand it, the US is one of the few developed nations that does not have a single payer system. Are they all wrong? I worked in the bay area with RNs from Canada who would not get US citizenship because they do not want to give up their excellent medial insurance in Canada. Why would that be?

I guess the tongue in cheek answers would be yes, and dementia. However, part of the problem is comparing apples and oranges. At the risk of the ire of the right, I would have developed a single payer system in the US as well, but I just wouldn't let our government run it. There is a big difference between how our government works and that of Luxembourg. What "works" there might not work here for a whole array of reasons, more on that later. As far as the Canadian system being "excellent", for some things it is. They are very good at preventative care, prenatal care, immunizations and simple problems. I assume your nurse friends never had a serious problem. They might think differently if they needed an MRI or open heart surgery, as they got sicker and sicker on a long waiting list. Seattle, Detroit, Buffalo, Albany, and to a certain extent Boston has a thriving business providing advanced care to Canadians who cross the border to utilize these services

While traveling in Australia, the people we met were all very happy with their universal health care.

Again, they tend to be happy as long as they don't get seriously ill.

No "death committees" in either country. Health care is considered a right in those countries as well as in the many other developed countries who rank above us in quality and outcomes.

I think "death committees" was a fear tactic of Sarah Palin and the far right. But you can only pay for universal health care either by higher taxes or rationing. European socialist republics do it with a little of both, something that Americans probably would not stand for.

I don't understand how that works. If universal health care is such a bad idea, why has it been so successful and well received in so many other nations? And why have we consistently ranked so low in outcomes?

Now here is the real fallacy with the arguments we hear all the time in the media. How successful is it, really. In Scandinavia, their 80% income tax is "well received"? And just ask the Greeks how it is working out for them. Italy, Spain, Portugal and Ireland are right on the same precipice. But more importantly, let's take a close look at the "low rank" of the US in health care
These so called rankings are generally based on life expectancy---the CIA World Fact Book ranks the US 43rd in this category. However, life expectancy to a large degree is a function of infant mortality, which the CIA ranks the US 57th in. But why? Almost every other country reporting infant mortality only counts live births after 34 weeks, some 36 weeks. We count every live birth---25 weeks, botched abortions, miscarriages--as long as the baby took 1 breath, we count it, therefore skewing the statistics.
There is also probably a genetic component to life expectancy as well. Japan is #1 or 2 on all the lists. The following is not racist, repeat that to all liberals, NOT RACIST, but fact--40 of the 42 lowest life expectancy countries are in Africa (the other 2 are Haiti and Afghanistan). Yes--- war, poverty, HIV and other disease and starvation are huge factors, but I wonder if some genetics is at play as well, as noted below
Even within the US, there is a large variation from state to state---from 81.3 years down to 75.0. Guess which state is #1----Hawaii, coincidentally a state with a high percentage of Japanese DNA. Which state is #50?---Mississippi, which in addition to some poverty and lack of access to care has a high percentage of African DNA (again, to liberals, fact, NOT RACIST)
Now let's look at the criteria by which the WHO rank the US system 37th in the world:
The rankings are based on an index of five factors:[2]
Health (50%) : disability-adjusted life expectancy
Overall or average : 25%
Distribution or equality : 25%

Responsiveness (25%) : speed of service, protection of privacy, and quality of amenities
Overall or average : 12.5%

Distribution or equality : 12.5%

Fair financial contribution : 25%


So, you can see how ridiculous this ranking is---every statistical factor works against the US and works in favor of small, genetically demographically homogenous populations that all pay high taxes.

I prefer the following test of the quality of the US health system:
When world leaders, royalty and billionaires get really sick, do they flock to NY City and Boston, or do they flock to "Luxembourg"?

Costs have increased dramatically during my years working as a RN, the
pay....not so much. The Hospital corporations are flush with cash, HCA for example, (Governor Rick Scott's former "ATM card") where I worked for the last 10 years has made record profits year after year. Their hospitals are 12 of the top 25 in profits year after year.

Some one is making a lot of $$ on the back of the health care industry, it's healthcare providers, and patients alike.


Well, it certainly wasn't me! But the last figures I saw 4 years ago showed 78% of all US hospitals were in the red. And doctors only account for 9% of every health care dollar. And if it's the "mega insurance companies", let's all go out and buy Humana stock. Remember, it's possible to take in tremendous amounts of money and still lose--just look at the federal budget!!

Well, "that's all folks":024: My arm is tired:1rotfl:

bimmertl 10-16-2015 06:27 AM

Quote:

Originally Posted by rxatkin (Post 1128150)
We just got a call from The Villages Health Care telling us that The Villages Health Care System is no longer taking new patients with Medicare as primary insurance and Tricare For Life as secondary insurance. That's just gone into effect today. We just got off the phone with the call center supervisor. Anyone else in our situation? They have too many patients and not enough doctors. Good luck to us veterans and our spouses.

Be sure to read the article in todays Daily Sun on page C1 title Villages Health Takes An Important Step . It states "Effective immediately the grassroots health care organization (Villages Health) will accept only United Healthcare Medicare Advantage plans for new patients."

So yes, there is room for new patients as long as you belong to the only Medicare Advantage plan that pays commissions to Morse. Nobody else can get in.

So don't believe the BS about Villages Health having to many patients. There's plenty of room if Morse gets a cut.

dbussone 10-16-2015 07:07 AM

Quote:

Originally Posted by bimmertl (Post 1129971)
Be sure to read the article in todays Daily Sun on page C1 title Villages Health Takes An Important Step . It states "Effective immediately the grassroots health care organization (Villages Health) will accept only United Healthcare Medicare Advantage plans for new patients."

So yes, there is room for new patients as long as you belong to the only Medicare Advantage plan that pays commissions to Morse. Nobody else can get in.

So don't believe the BS about Villages Health having to many patients. There's plenty of room if Morse gets a cut.

You didn't need a program to see this coming. In fact I will predict that the developer's exit strategy for the so called health system ultimately involves a sale to UHC.

trichard 10-16-2015 07:56 AM

You are so right! It is all about the money. The villages health is a great concept that is sucking a lot of red. The developer has been subsidizing the operation into the millions each month. I believe they thought Unitedhealthcare's MA program would grow substantially with the association with the villages. That did not happen so the anticipated payer mix did not generate the projected capitated payment revenues. This move positions the system for a stock buyout. Stock is held by management and physicians. The most likely buyer is United Health Care. Meanwhile, where will the original Medicare patients go? A smart move for a quality primary care group would to set up shop adjacent to the villages.

NYGUY 10-16-2015 08:57 AM

Quote:

Originally Posted by dbussone (Post 1129982)
You didn't need a program to see this coming. In fact I will predict that the developer's exit strategy for the so called health system ultimately involves a sale to UHC.

That is a reasonable prediction!!

Villageswimmer 10-16-2015 09:03 AM

Quote:

Originally Posted by trichard (Post 1130002)
You are so right! It is all about the money. The villages health is a great concept that is sucking a lot of red. The developer has been subsidizing the operation into the millions each month. I believe they thought Unitedhealthcare's MA program would grow substantially with the association with the villages. That did not happen so the anticipated payer mix did not generate the projected capitated payment revenues. This move positions the system for a stock buyout. Stock is held by management and physicians. The most likely buyer is United Health Care. Meanwhile, where will the original Medicare patients go? A smart move for a quality primary care group would to set up shop adjacent to the villages.


Not disputing this post, but what is the source of this info?

dbussone 10-16-2015 09:23 AM

Quote:

Originally Posted by NYGUY (Post 1130053)
That is a reasonable prediction!!


Thank you!

outlaw 10-16-2015 10:07 AM

Whatever happens, I'm sure it will be in our best interest.

NYGUY 10-16-2015 12:20 PM

Quote:

Originally Posted by outlaw (Post 1130096)
Whatever happens, I'm sure it will be in our best interest.

:1rotfl::1rotfl:

deemelvin1@gmail.com 10-16-2015 12:26 PM

I'm interested to know how our veterans feel about the article in the paper today announcing changes to The Villages Health. This includes that they will will no longer be accepting new patients covered by military healthcare (Tricare to include Tricare for Life/Medicare). I called to verify this was correct and was told it is. I personally feel this is just another example of groups paying lip service to supporting our troops when, in fact, they do not.

trichard 10-16-2015 02:01 PM

Quote:

Originally Posted by Villageswimmer (Post 1130063)
Not disputing this post, but what is the source of this info?

One of the docs.

nkrifats 10-16-2015 02:54 PM

Quote:

Originally Posted by deemelvin1@gmail.com (Post 1130167)
I'm interested to know how our veterans feel about the article in the paper today announcing changes to The Villages Health. This includes that they will will no longer be accepting new patients covered by military healthcare (Tricare to include Tricare for Life/Medicare). I called to verify this was correct and was told it is. I personally feel this is just another example of groups paying lip service to supporting our troops when, in fact, they do not.

Villages Health is not only ones doing this walgreens is a prime example, they will not fill a prescription if you are using Tricare. Villages Health cut off others also. What about them? They made a business decision.. II don't feel that they are paying lip service. I have run into same situation when company I worked for switched plans and my DR did not accept new plan. The Village Health did keep those already enrolled. A point to consider.

Navy (SSBN 633) 10-16-2015 04:38 PM

I am retired Navy and granfathered in "for now"..but feel certainly feel the change is kind of a slap in the face to our VETS!!!

Fredwms 10-16-2015 05:19 PM

Curious about the hospital in TV
 
Does the hospital accept Medicare & Tricare for Life? Also, my Medicare advantage plan is through Humana. Does the hospital accept Humana?
:shrug:

dbussone 10-16-2015 05:26 PM

Quote:

Originally Posted by Fredwms (Post 1130309)
Does the hospital accept Medicare & Tricare for Life? Also, my Medicare advantage plan is through Humana. Does the hospital accept Humana?

:shrug:


I would recommend you call their business office. Most likely they do. However, the $ you pay out of pocket may not be what you expect. That depends on the specific contract the hospital has with each provider.

Medicare tells the hospital what it will pay. Humana is a different story though.

Challenger 10-16-2015 05:42 PM

Quote:

Originally Posted by Fredwms (Post 1130309)
Does the hospital accept Medicare & Tricare for Life? Also, my Medicare advantage plan is through Humana. Does the hospital accept Humana?
:shrug:

If you have Medicare and Tricare for Life, why are you paying Humana premiums? Just wondering!!!

liliana42 10-16-2015 07:23 PM

As of today, The Villages Health is no longer accepting new regular medicare patients--only UHC medicare advantage ones. And I was told by the billing department that even though this applies to new patients only, they are sending letters to let current patients know that this will be applying to them as well (though I don't know when the cutoff date is).

jrandall 10-16-2015 08:49 PM

Quote:

Originally Posted by dotti105 (Post 1129444)
One of my big concerns with the huge monopoly type insurance companies who buy up their competition is the fact that they have a very large lobby which is an industry in and of itself. They are proud of the fact that they line the pockets of the house and senate members who are elected to represent OUR best interests. Our representatives are no longer representing us, they are representing the special interests who pay them well to do so.

Citizens United needs to be overturned and term limits in place before we will have elected officials who are willing to represent the citizens who voted them into office. $$ is running politics now, and big business supplies the big bucks. The insurance industry is one of the largest and most successful in getting laws drafted to their advantage.

When ACA came out with Insurance Companies in charge, we were guaranteed to have higher premiums, co-pays and less option for seeing the provider/specialist of our choice.

As they have put out the programs for 2016, there have been many changes and most are again in the favor of the insurance companies.

Our healthcare system, like our political system would be better run without the SuperPacs, and lobbyists who have the insidious power to determine our political future and the future of our healthcare, to a much greater degree than the citizens who elected those officials.

That is a recipe for disaster for all except the big boys with the big bucks.

Ft

So very and sadly true!

rxatkin 10-16-2015 09:19 PM

Quote:

Originally Posted by graciegirl (Post 1128413)
You are very fortunate to have been accepted. I would love for us to be patients there. Unfortunately they have always only accepted certain kinds of insurance.


I have a feeling that this isn't a change, just their way of doing business and only certain kinds of insurance participate and are accepted.

I got into the program about two weeks ago. My wife had to wait until she was Medicare eligible and they called her to tell her she couldn't participate now. It is a definite change in the program as outlined in The Daily Sun today. Of course, they left out the part of excluding Medicare and Tricare For Life as primary and secondary payers. Another knife in the back of Veterans and their families.

rxatkin 10-16-2015 09:20 PM

Quote:

Originally Posted by Navy (SSBN 633) (Post 1128559)
Medicare and Tricare for Life are still listed on their web site as acceptable insurances they accept.

Believe me, try to do it now. Their web site is probably changed by now.

rxatkin 10-16-2015 09:22 PM

Quote:

Originally Posted by bimmertl (Post 1128588)
There is still plenty of room for new patients if you sign up with United Health Care Medicare Advantage. It's the only Medicare Advantage plan accepted by The Villages Health network. (It's Medicare Advantage, not plain Medicare, a big difference)

Accepted Insurance by The Villages Health

Two inserts in the Daily Sun already this week in addition to the weekly Sunday paper pages devoted to the product. Look at the brochure and see how many neighborhood meeting are being held from October 13 through December 3. It lists 52 different locations with multiple meetings at each location. In addition, you can walk into one of three UHC Medicare Stores located in the Villages. Based upon the numbers of meetings and unlimited access to sales personnel there is plenty of room for more patients in UHC Medicare Advantage.

As stated in the brochures, "United Healthcare pays royalty fees to Holding Company of the Villages, inc.". So there is always room for more patients as long as Morse makes a profit, otherwise SOL.

You got it!

rxatkin 10-16-2015 09:36 PM

Quote:

Originally Posted by bimmertl (Post 1129971)
Be sure to read the article in todays Daily Sun on page C1 title Villages Health Takes An Important Step . It states "Effective immediately the grassroots health care organization (Villages Health) will accept only United Healthcare Medicare Advantage plans for new patients."

So yes, there is room for new patients as long as you belong to the only Medicare Advantage plan that pays commissions to Morse. Nobody else can get in.

So don't believe the BS about Villages Health having to many patients. There's plenty of room if Morse gets a cut.

That's pretty much it in a nutshell!

rxatkin 10-16-2015 09:39 PM

Quote:

Originally Posted by deemelvin1@gmail.com (Post 1130167)
I'm interested to know how our veterans feel about the article in the paper today announcing changes to The Villages Health. This includes that they will will no longer be accepting new patients covered by military healthcare (Tricare to include Tricare for Life/Medicare). I called to verify this was correct and was told it is. I personally feel this is just another example of groups paying lip service to supporting our troops when, in fact, they do not.

That's the way this Air Force retiree sees it as well.

sirknor 10-17-2015 05:28 AM

I'm happy with UHC.

outlaw 10-17-2015 06:18 AM

This is what is referred to as "turning the screws".

golfing eagles 10-17-2015 06:29 AM

Quote:

Originally Posted by outlaw (Post 1130451)
This is what is referred to as "turning the screws".

Perhaps. Or perhaps it has to with federal regulation pertaining to ACOs. Just as the federal regulators have decided that 80% of homeowners have to be over 55 to qualify as an adult community, there MAY be a regulation requiring a certain percentage of enrollees in an ACO have a medicare advantage plan. As TV Health aims to be an ACO, they may need to meet a requirement. I don't know if it is true, but certainly possible.

dbussone 10-17-2015 07:14 AM

Quote:

Originally Posted by golfing eagles (Post 1130456)
Perhaps. Or perhaps it has to with federal regulation pertaining to ACOs. Just as the federal regulators have decided that 80% of homeowners have to be over 55 to qualify as an adult community, there MAY be a regulation requiring a certain percentage of enrollees in an ACO have a medicare advantage plan. As TV Health aims to be an ACO, they may need to meet a requirement. I don't know if it is true, but certainly possible.


GE - I'm not certain about that either. The Feds announced their plan to eliminate Advantage plans over the next several years.

Navy (SSBN 633) 10-17-2015 09:39 AM

Quote:

Originally Posted by rxatkin (Post 1130400)
Believe me, try to do it now. Their web site is probably changed by now.

you are correct..web site changed....Retired Military booted...ugh

dillywho 10-17-2015 11:26 AM

Not for Me
 
I prefer to choose my own doctors.....not have them chosen for me. No, thank you.

As for not taking military insurance, not good at all. These people devoted themselves to taking care of us, protecting our freedoms, etc. and this is how they are repaid? Yes, they were protecting the very freedom that VHC is exercising, but that doesn't make it right.

graciegirl 10-17-2015 12:12 PM

...

golfing eagles 10-17-2015 12:20 PM

Quote:

Originally Posted by dillywho (Post 1130598)
I prefer to choose my own doctors.....not have them chosen for me. No, thank you.

As for not taking military insurance, not good at all. These people devoted themselves to taking care of us, protecting our freedoms, etc. and this is how they are repaid? Yes, they were protecting the very freedom that VHC is exercising, but that doesn't make it right.

Do you know if they are just no longer taking NEW patients with Tricare or also ditching existing patients. It looks as though they are not taking ANY new patients other than UHC Villages Medicare Advantage, but they sent us a letter stating not to worry, they are keeping us with our existing insurance (not Tricare)

JoMar 10-17-2015 12:40 PM

Quote:

Originally Posted by Navy (SSBN 633) (Post 1130540)
you are correct..web site changed....Retired Military booted...ugh

I don't see this as Vets being booted, rather than the plans being booted. I know many retired vets that are in the health system but they have acceptable plans. Some posts seem to suggest that the Villages Health Care is the only provider that does not accept Tricare and that is false, there are many providers that do not accept Tricare. Why? Seems the "negotiated rate" that Tricare is looking for is below the minimums the provider can accept. I suspect that VHC has made a business decision with UHC that is in it's best interests while Tricare and other health care plan providers try to do the same thing in negotiating rates. As a vet, I understand that I am not entitled to stuff but that if the government or other businesses provides opportunities I have a choice to take advantage of it or not. Health care providers run a business and they have every right and an obligation to run their business's in a profitable profile. VHC made a decision on what works in their interests and decided to get in bed with UHC. You as an individual made a decision on what works in your interest and decided to get in bed with Tricare. Since there are other doctors and providers in the area that do accept medicare and tricare you can still receive services.

Challenger 10-17-2015 01:33 PM

Quote:

Originally Posted by JoMar (Post 1130653)
I don't see this as Vets being booted, rather than the plans being booted. I know many retired vets that are in the health system but they have acceptable plans. Some posts seem to suggest that the Villages Health Care is the only provider that does not accept Tricare and that is false, there are many providers that do not accept Tricare. Why? Seems the "negotiated rate" that Tricare is looking for is below the minimums the provider can accept. I suspect that VHC has made a business decision with UHC that is in it's best interests while Tricare and other health care plan providers try to do the same thing in negotiating rates. As a vet, I understand that I am not entitled to stuff but that if the government or other businesses provides opportunities I have a choice to take advantage of it or not. Health care providers run a business and they have every right and an obligation to run their business's in a profitable profile. VHC made a decision on what works in their interests and decided to get in bed with UHC. You as an individual made a decision on what works in your interest and decided to get in bed with Tricare. Since there are other doctors and providers in the area that do accept medicare and tricare you can still receive services.

makes sense to me!!!

PTennismom0202 10-17-2015 02:58 PM

TV Health
 
We have only lived in The Villages 2 years but have already had 3 PCPs leave. I qualify for TV Health based on my insurance coverage, but my husband doesn't. We have not had good experiences with specialists. The hospital doesn't have a good patient experience score from Medicare.

https://www.medicare.gov/hospitalcom...ng=-81.8879884

We are seriously considering leaving TV because we can't rely on getting good health care here.

Fredwms 10-17-2015 03:25 PM

My fiancé has Tricare for Life
 
Quote:

Originally Posted by Challenger (Post 1130325)
If you have Medicare and Tricare for Life, why are you paying Humana premiums? Just wondering!!!

My fiancé's ex was a Navy captain and she qualified for Tricare under their 20/20 program (20 years in service and 20 years married). I personally have Humana Advantage under Medicare as I am not military and not eligible for Tricare.

Radioman41 10-17-2015 07:25 PM

I'm not sure what Villages Health was thinking when establishing this new policy. There are many retired federal employees moving to The Villages. I doubt if they will give up, or suspend their federal health plan (fep ~ very often Blue Cross) for Medicare Advantage in order to join Villages Health. With Medicare A & B along with fep insurance, a retired federal employee can get medical care almost anywhere if necessary.

ekdk92 10-17-2015 07:48 PM

This policy means the Villages Health is not available to anyone under age 65.

Doesn't seem to fit the needs of a 55 and over community.

Mikeod 10-17-2015 08:11 PM

Quote:

Originally Posted by ekdk92 (Post 1130936)
This policy means the Villages Health is not available to anyone under age 65.

Doesn't seem to fit the needs of a 55 and over community.

No, it just means medicare eligible members are restricted to one advantage plan. If you don't want or aren't eligible for that plan, you must look elsewhere for service.


All times are GMT -5. The time now is 08:05 PM.

Powered by vBulletin® Version 3.8.11
Copyright ©2000 - 2025, vBulletin Solutions Inc.
Search Engine Optimisation provided by DragonByte SEO v2.0.32 (Pro) - vBulletin Mods & Addons Copyright © 2025 DragonByte Technologies Ltd.