Real Medicare pays bills when they’re presented. Medicare Advantage insurance companies, on the other hand, get a fixed dollar amount every year for each of the people enrolled in their programs, regardless of how much they spent on each customer.
Not only that, when people do figure out they’ve been duped and try to get back on real Medicare, the same insurance companies often punish them by refusing to write Medigap plans (that fill in the 20% hole in real Medicare). They can’t do that when you first sign up when you turn 65, but if you “leave” real Medicare for privatized Medicare Advantage, it can be damn hard to get back on it. (...)
With real Medicare and a Medigap plan, you talk with your physician or hospital and decide on your treatment, they bill Medicare, and you never see or hear about the bill. There is nobody between you and your physician or hospital and Medicare only goes after the payment they’ve made if they sniff out a fraud.
With Medicare Advantage, on the other hand, your insurance company gets a lump-sum payment from Medicare every year and keeps the difference between what they get and what they pay out. They then insert themselves between you and your doctor or hospital to avoid paying for whatever they can.
Whatever you decide on regarding treatment, many Advantage insurance companies will regularly second-guess and do everything they can to intimidate you into paying yourself out-of-pocket. Often, they simply refuse payment and wait for you to file a complaint against them; for people seriously ill the cumbersome “appeals” process is often more than they can handle.
As a result, hospitals and doctor groups across the nation are beginning to refuse to take Medicare Advantage patients. California-based Scripps Health, for example, cares for around 30,000 people on Medicare Advantage and recently notified all of them that Scripps will no longer offer medical services to them unless they pay out-of-pocket or revert back to real Medicare.
They made this decision because over $75 million worth of services and procedures their physicians had recommended to their patients were turned down by Medicare Advantage insurance companies. In many cases, Scripps had already provided the care and is now stuck with the bills that the Advantage companies refuse to pay.
Scripps CEO Chris Van Gorder told MedPage Today:
“We are a patient care organization and not a patient denial organization and, in many ways, the model of managed care has always been about denying or delaying care – at least economically. That is why denials, [prior] authorizations and administrative processes have become a very big issue for physicians and hospitals...”
Similarly, the Mayo Clinic has warned its customers in Florida and Arizona that they won’t accept Medicare Advantage any more, either. Increasing numbers of physician groups and hospitals are simply over being ripped off by Advantage insurance companies.
by Thom Hartman, Alternet | Read more:
Image: Physicians for a National Health Program (PNHP); Our Payments Their Profits (pdf)[ed. As this article notes, we're currently in an open enrollment period for Medicare, and MA scammers are carpet-bombing America with advertisements, relying on confusion and deceptively low initial or monthly payments to entice people to essentially screw themselves (60 million of them). See also: As Scandals Mount, So Do Calls to Abolish Private Medicare Advantage Plans (CD); How Medicare Advantage Plans Dodged Auditors and Overcharged Taxpayers by Millions (Kaiser Health News); and if that's not enough: Seniors’ Medicare Benefits Are Being Privatized Without Consent (The Lever). Our American health care system. Hardly a system at all, just a free for all rip-off spree - left to right, top to bottom. Three words: Medicare For All.]
