Ed Notes Extended

Wednesday, April 28, 2021

Don't be gaslit - Medicare Advantage Horror Story

...the most important fact to keep in mind is that insurance companies are in business to make profits. The more the better. So after all the expenses of doing business they have, they have to keep the shareholders happy by having great profits. Their customers have to pay for profits. The medical costs they are responsible for paying is not a happy event for them.  ---- Facebook correspondent

Their all in cahoots - add unions

My wife worked in the medical billing field for decades and always pointed to Medicare govt run plan as being the most efficient and cost saving while private companies delayed payment and had lots of people working there who were not as capable as the professionalism of medicare people.

The thing to understand is that Medicare Advantage plans are private but have created purposeful confusion by taking the medicare name and attaching a new label. And they pay less than public medicare so many doctors won't take advantage plans. It's very like the old HIP which we always had an option to take but most of us didn't because of the permissions, limited docs, etc.

Here's what I wonder - if we had medicare for all this issue wouldn't even be on the table but the unions like the UFT are adamantly against it. So what is the advantage to unions to support a plan that fucks up so many people? Is there some sort of quid quo pro for the leaderships from private insurance since it seems like such a no brainer to end the profit system of health care?

I saw this on FB and it's not the first I heard of delays on getting to doctors when having to go through the primary physician gatekeeper who can stop you in your tracks if he doesn't approve.

I’m married to a man who is a retired NY teacher, so this change will impact me. 
Having been covered by a Medicare Advantage plan before we married, I can tell you the blah blah corporate speak is baloney. 
Here are some facts to think about.
Administering the Medicare program costs 2%, while private insurance companies pay between 12 and 18% to administer their programs. The insurance companies also have the expenses of paying executives high salaries and bonuses, country club memberships and expenses, and whatever other perks they get, and paying dividends to their shareholders. How can they possibly claim it will cost the insured less? Less of the premiums paid will go for medical care, that’s for sure. 
When the people negotiating the programs say the retirees will have better medical care, that is like sprinkling fairy dust on our brains. You can’t call a specialist and make an appointment. You have to see your primary care doctor and get his approval to do that, and he has to give the doctor you want to see a referral. Some offices are less efficient than others, and your referral may not get to the specialist. 
You can’t go to a hospital without going through the same thing unless it’s an emergency situation. You can’t get a test or procedure or surgery or anything out of an ordinary office visit without getting a referral. The specialist cannot order these things for you. It has to be your primary care physician, who is not an expert in anything. 
My late husband and I had a Humana advantage plan, and I’m convinced it caused his death. 
He became ill with a cough and his physician treated him for post nasal drip. He was getting worse instead of better. We wanted to go to a pulmonologist, but specialists cost the primary care physicians money (a great incentive to keep costs for the insurance companies down), so he wouldn’t approve it. Finally, when we were in the office one day after several months of worry, I loudly, with a waiting room filled with patients, shouted, “My husband is getting more and more sick and is losing weight like crazy, and I don’t see any concern from you. Look at him! He has to see a pulmonologist!” The doctor said “His lungs are clear.” I said “I’m sitting 10 feet away from him and I can hear him wheezing from here! Don’t tell me it’s post nasal drip!” He listened to his lungs with a stethoscope and finally agreed to give him the referral. Of course, when we went to the pulmonologist, they hadn’t received it, but their staff made a phone call and had it sent over. But that kind of stress is what we had to deal with when we were dealing with lung cancer. And that wasn’t the end of it. My husband had many, many scans, endoscopies and biopsies without finding a single cancer cell, all while he had advanced lung cancer and his chest kept filling with fluid. 
Don’t let them subject you to this. You deserve better, which you have now.


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