Millions of people over the age of 65 sign on the dotted line to participate in a Medicare Advantage plan. You cannot watch any television during daytime without seeing frequent ads for Humana, United Health Care, or Blue Cross Blue Shield trying to stress how much better their plans are compared to Medicare.
They are very good ads They seem like you have no choice but to call and find out what you are missing out on. It is easy to see how easily seniors can be sold on these plans. Who does not want to save money and get more?
Save money and get more?
Wait did I just say that? Well I have also heard a good saying, “If it sounds too good to be true, then it is not.” While it is true that some of these plans do add some coverage that traditionally is not accessible to regular Medicare, there are significantly more control over your regular benefits.
These seniors are now part of a Managed care system that requires frequent prior authorization for care, continuous oversight during care, and denial of medically appropriate services that would normally be covered by Medicare.
Back in the news again
So these wonderful companies have a tendency to pop up in the news from time to time. Unfortunately they don’t get enough headlines for the general population to really take notice.
Recently Humana has recently popped up with their decisions to terminate some Advantage plans as well as change coverage levels depending on the part of the country you live in. So the explanation was these programs were not profitable enough to keep as a plan.
So your selling point to these seniors is you need to go to this wonderful program, or even worse stay with the company on a different plan, all while basing your plan structure as to what is the most profitable? So we are now flat out admitting that profits prevail over care?
Enter the lobbying
So now we have the trade groups and lobbying arms pushing for more money for beneficiaries they cover as well as less oversight.
Yes you heard that right. They are pushing for more money from the Federal government while saying, “trust us, we will do the right thing, just don’t look.”
Continuing litigation
So they are still under litigation for denial of care and basing plans of care on an algorithm. The class action lawsuits are still working their way through the court system. According to the litigation, these companies were denying services that were reasonable and necessary to allow for recovery from a hospitalization.
The lawsuits also include the use of algorithms to plan coverage and discharge planning for all episodes of care instead of individualized care based on medical need and other diagnosis that would effect timing of outcomes.
Sounds kind of funny to ask for no oversight?
So while in the process of getting sued for inappropriate practices and denying care, you actually ask for no oversight? Correct me if I am wrong, but would the oversight help to protect seniors from exactly what you are being sued for?
So what can we do?
We need to advocate for our seniors. We need to let our local representatives know how the deceptive practices of manged care Medicare directly impacts our seniors. We also need to assist our elderly to be fully educated and informed on what they are being offered. They need to be able to make a wise decision on their coverage and not be swayed by a good salesman. So be a voice and be the change. It truely affects us all.
