The escalating cost of health insurance, prescription drugs and medical care across the country has created a national crisis. Hospitals and drug companies are charging increasingly exorbitant amounts... Michael Mulgrew in UFT FAQ. (See it debunked -The Facts Michael Mulgrew, UFT, Doesn’t Want You to know.)
Another way is to pressure Medicare to be more vigilant - see the article below
Preauthorizations – a cautionary tale
October 23, 2022... the oncologist frowned. Unfortunately, the scan couldn’t be scheduled for 3 or 4 weeks. “We’re not the problem...We have to get approval from your insurance. We’ll submit it, they’ll reject it. There’s a lot of back and forth.” Barry was puzzled. …“Just to be clear,” he said, “I’m not in Medicare Advantage. I have regular Medicare with a supplemental.” The oncologist’s “whole demeanor changed.” … The frown became a smile. “Well then, we can go a lot faster,” he was told.
Prior Authorization: Who saves? Who loses?
October 24,
Who saves?
- The City
- The Stabilization Fund
- Michael Mulgrew
- The Insurance Companies
Who pays?
- Soon? Retirees. (unless we stop them)
- Eventually? All of us.
- (and the federal government)
Mulgrew raises copays; Bronx gets hit
Do you know what health care savings are? They (insurance companies, Michael Mulgrew, the New York Times) call it savings when 1) you think about going to the doctor, and decide not to and 2) when you pay more (and they pay less) for your visits.
So what do they call it when your copay goes from $50 to $100? Or from $0 to $30? That’s right – the MLC and the UFT leadership call that SAVINGS. Doesn’t feel like savings when it costs me more. How about you?
More on the New Emblem (GHI) Copays
We are talking MRIs, CAT scans, PET scans, NMR, and other stuff. Copays in network were $50. But the City and the MLC and Mulgrew and the Insurance companies found a cost savings. (Cost savings mean you get less medical care, or you have a harder time accessing medical care, or you have to pay more out of pocket for medical care. “Cost Savings” is short for “Cost Savings for them, at our expense”)
In any case, the way they are going to charge us more is by declaring everyone to be out of network, with double the copay ($100 instead of $50).
Did the UFT make an announcement about copay increases?
October 27, 2022Maybe I missed it? I have been writing about the increase in GHI (now Emblem) copays, for Montefiore, and for MRIs, CTs, and other scans.
I have pointed out that the notice from Emblem came AFTER the changes went into effect. I have also pointed out that the notice from the UFT NEVER CAME. I searched my mail. I searched my email. Could I have missed it? Please readers, tell me if I have. But I don’t think so.
Tuesday at a UFT meeting two UFT officers indicated this was the first they had heard of it, and that they had not seen it in writing. This is a change to copays for the insurance (Emblem, used to be GHI) that most high school teachers have.
Yesterday I got an email over Mulgrew’s name about healthcare – I read carefully to see if they snuck in a mention of the new copays. Nope. Mulgrew and friends just decided not to tell us about the new copays. Let Emblem do it. Or let the members find out when they get a surprise charge at the doctors office. This, by the way, is tried and true Unity strategy. When they have bad news, hide it.
Aiming to reset the debate over the future of the healthcare provided retired New York City civil servants, the president of the largest municipal union insists he wants the City Council to change the city’s administrative code — not to force retirees into a controversial Medicare Advantage Plan as critics claim — but to preserve all city unions’ collective bargaining rights.
On an Oct. 20 virtual press call, Michael Mulgrew, president of the 200,000 member United Federation of Teachers, told reporters that New York State Judge Lyle Frank’s ruling last October “undid 40 years of collective bargaining” and that while an appeal is still pending, the City Council needs to revise the administrative code to preserve the unions’ ability to offer a myriad of healthcare plans to the city’s 200,000 retirees.
Complete article: https://portside.org/2022-10-27/uft-prez-doubles-down-medicare-advantage-push-face-fierce-opposition
And one more. While we support Medicare, we don't support the lax admin when it comes to fraud. People at the top of MC often move back and forth between govt and industry. If we want to save money let's keep an eye on the corrupt ball.
Medicare Rights: CMS to Release Audit Findings on Overpayments to Medicare Advantage Plans
https://www.medicarerights.org/medicare-watch/2022/10/27/cms-to-release-audit-findings-on-overpayments-to-medicare-advantage-plans
- By Lindsey Copeland
- October 27, 2022
The Centers for Medicare & Medicaid Services (CMS) has agreed to release the audits of 90 Medicare Advantage (MA) plans conducted between 2011 and 2013. The records are expected to detail more than $600 million in MA overpayments due to “upcoding,” plan abuses of patient categorization rules. Access to this information was the subject of a lawsuit filed by Kaiser Health News (KHN) against the agency in 2019 under the Freedom of Information Act.
At Medicare Rights, we agree more transparency on plan operations and more accountability for plan use of public dollars is long overdue. It is also ever-more urgent as plans, enrollment, and spending continue to grow.
As a share of total Medicare spending, payments to MA plans increased from 26% in 2010 to 45% in 2020 and may reach 54% by 2030. By itself, upcoding could cost Medicare $600 billion over the next decade. At the same time, MA enrollment more than doubled over the last decade. The share of beneficiaries enrolled in MA, now at 48%, may hit 61% by 2032. Yet, the data are unclear when it comes to MA quality, and there is a dearth of reported demographic information, further undermining transparency and stymieing equity advancement efforts.
Policymakers must intervene. Inflated payments to MA plans require robust reforms, including updated payment methodologies, better data collection, and stronger plan oversight.
And we can’t stop there. As watchdog research has long shown, plans also regularly seek to pad profits by stinting on care. Each year, prior authorization and inappropriate denials leave millions with high costs and care delays.
We frequently hear from beneficiaries trying to navigate such denials. Many are upset and confused about what to do next. Despite sky-high overturn rates, most avoid the intimidating appeals process. Instead, they pay out-of-pocket, go into debt, or go without care entirely. Even successful appeals come at a cost, generating access delays and administrative burdens.
Others may leave MA and return to Original Medicare. This switch is particularly common among the sickest and highest-cost enrollees, suggesting barriers may multiply alongside health needs and expenses. While this can ease access, it often takes months and carries no guarantee of affordable supplemental coverage.
The only clear winners in these scenarios are the plans. They collect enrollee premiums and capitated payments, then later avoid paying for promised care through denials and disenrollments.
Not all MA insurers are bad actors, of course. But surging plan numbers make it easier for those who are to skirt the rules and exploit loopholes. Rapid enrollment growth—in part due to overpayments, which plans use to offer benefits unavailable in Original Medicare—is entangling more people in a flawed system.
We urge a thorough restructuring to deter overpayments; equalize Medicare benefits; realign payment incentives; and ease access to care, including by limiting prior authorization, preventing erroneous denials, and streamlining appeals processes. All people with Medicare deserve a system that works for them, regardless of the coverage pathway they choose.
Read the KHN article, “Lawsuit by KHN Prompts Government to Release Medicare Advantage Audits.”
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