Village health- complain about ins. change
 

Village Heath is keeping track of complaints being voiced by the change in health ins coverage. I went up to the front desk & asked if they are keeping track. My name & reason for the complaint was recorded. I have Medicare & supplemental as part of my retirement, which is paid for & I can't switch. My partner, who is not 65 would also lose coverage if I switched.
I think it is important not to be silent! Voice your concern & have it be counted!

They might take the complaint but they have already made their business decision. We are all scrambling now to find new doctors and we will not return to their system again. They are losing money now and will lose a lot more when we are all out!

The way to make your voice heard is to leave.

There are a lot of things you can say about The Villages. Bad business decisions are not among them.

If that were true, they would not have had to fork out $40 million to settle a lawsuit. Just to name one...

I heard that out of about 15,000 people that are affected they expect 60 percent to drop out and they will let 6 doctors go. Remember the doctors are on salary and when you add in their benefits and assistants the savings are substantial.

Sources please.

Time will tell how this decision plays out. i am sure they have made many bad decisions and they hopefully have learned from them. This one is very controversial and very much in the public eye. No hiding this outcome.

What category would the Moffitt charade be put into?

The current change is most certainly not a new thought on the part os management.

In both cases there was a core or base business load that was required to meet what ever the financial objectives were.

When reached the Moffit disband came to light....was in the works all the time.

Ditto for the Marcus Welby charade......you can keep your insurance....they forgot to finish the sentence....for now.

Both incidents are classic examples of bait and switch.

I will keep my medicare plus supplement and doctors and specialists of my choosing....nation wide.
I will also keep The Villages hospital as second choice only.

As a result of these two incidents...one can only witdraw trust in future proposals from TV.

The decision makers know they will take some flak for a period of time and then things will quiet down. Their schedules will be sufficient to run their businesses. All will be well until another shoe drops.

This was mentioned at last nights POA meeting.

The online poll from the unnamed source has 78% leaving as of yesterday, did not look today.

Just because it's not what you want does not make it a bad decision for them. There must a lot of former government employees in the villages who had premium insurance plans all of their working careers. I worked in an industry where our insurance carrier changed every other year and the doctors we were familiar with were dropped periodically. It's what companies do to stay in business. Get used to it!

So.....if I like my doctor at Villages Health and decide to get their insurance I could lose my doctor anyway.

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.

Of course. Doctors can always leave. And have.

They do not care about veterans (they will not take Tricare) and now they are only taking some forms of Medicare. It appears they only want money - not being doctors that care about people. Shame

My point that was missed;

the charade and pomp and circumstance that was used to get people to donate, support, change health care providers to lure and build a customer base.

My position is it was a known strategy before they started soliciting residents. They secured donations and patient base targets and then announced getting rid of loyal customers.

No need to promote getting used to deceit and trickery.

If they were responsible care givers they would have grandfathered those they sucked in in the first place.

They have proven to not be not CARE, givers!

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

Same situation. I have medicare and supplement thru my retirement. Why would I want to pay for Medicare Advantage. I will now be in the care of one doctor which I really think I should have done in the first place. I think I will like it better than seeing a different person (PA) every time I have a visit and get to see my primary doctor only for wellness visit. This is probably for the best.

agree!

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.

Village health- complain about ins. change
 

I do think there is a very real generational expectation whereby the first baby boomers and their predecessors are more inclined to believe that the "system" is paternalistic. This is how they were raised and any deviation from their expectations is apparent in the many threads and postings on here. It's a shame because it would be nice if what they believed were really true. Thing is, it never was true.

I generally agree, except I think there was a time, more than 50 years ago, when it was true. There was no health insurance, no medicare or Medicaid, no government intervention, almost no malpractice. "Marcus Welby" would take a dozen eggs from a farmer if they could not pay the fee for an office visit, which by the way was about $3.
Why have healthcare costs skyrocketed?
1) high cost of advanced technology
2) high cost of gov't and ins. co. paperwork
3) the mere presence of third party payers
4) the cost of malpractice and defensive medical practice
5) enormous waste and fraud in gov't programs
6) the advent of specialists, sub-specialists and sub-sub-specialists

According to the AMA, just the cost of having employees to deal with insurance denials and prior approvals costs each clinician $55/hour. The cost of defensive practice is estimated between $250-$750 BILLION/year. Private insurers will administer a plan for about 12-13%, government programs cost 31% (DO NOT believe the hype of 2-3%, it does not include all the costs that are born by government agencies other than CMS---office space, premium collection, computer expense, postage, savings from operating across state lines, etc)

Unfortunately, medicine is now so complicated that there is no way to go back to the days of "Marcus Welby" , but perhaps there is a happy medium somewhere.

Read this post. Then print it and frame it. Refer to it often.

Standing O!! :coolsmiley:

Thank you, GG. But while I think it's a reasonable post, I doubt it will make the NY Times non-fiction best seller list:1rotfl::1rotfl::1rotfl:

Exactly! They were not responsible care givers as you said. If they were, they would have cared about their patients first. I had received a letter a while back stating I would be grandfathered. TVH should honor that promise to their existing patients. Honor the promise to Those you rallied from the beginning. Honor your promise to Those that supported you from day one. We understand that there needs to be different business decisions from this point, but honor the promise you made as an ethical, caring health care provider. TVH has darkened it's' image and that reflects on TV community and the developer.

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

First, read post #21 regarding the ethics and caring of the providers
Second, stay healthy

Third, are you saying that you received a letter from TVH stating that no matter what changes they made to their accepted insurances, no matter what changes YOUR insurance company made with regards to TVH (including, by the way, denying participation totally), and no matter what changes came down in national health care policy from Washington, D.C., that they would forever and in perpetuity accept the insurance plan that YOU had at the time you enrolled? If so, I'd love to see THAT letter, then donate it to the Smithsonian as a one of a kind, unique correspondence unparalleled in the history of healthcare.

Fourth, once again no patient is being "dumped", it's certain insurances that are being dumped. And before anyone jumps down my throat, I'm in the same boat as everyone else. And if you do jump down my throat, I plan on regurgitating you anyway:1rotfl::1rotfl::1rotfl:

I'll second that. As we used to say in corporate medicine (and yes medicine is a business) - No margin; no mission!

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.

:agree:

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".

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.

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.

Now, that's using your noodle! Bravo!

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.

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.

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'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.