Thread: Private Medicare Advantage under fire

Private Medicare Advantage under fire

Denial of service routine, critics say

By Matt Sedensky

ASSOCIATED PRESS
2:00 a.m. August 30, 2009

MIAMI — Cecile Sangiamo liked her health insurance — until she needed to use it.

Sangiamo, 72, of Clearwater, Fla., had been on the federally subsidized, privately run Medicare Advantage policy through WellCare Inc. for about three years when she started having pain that made it hard to walk.

Her doctor's referral to an orthopedic specialist was denied by the insurer. Her out-of-pocket costs were higher than she was initially told. And when Sangiamo needed surgery, she said, WellCare offered some unexpected medical advice.

[b]“Take pills and use a walker,â€

Participants have been denied visits to specialists, rehabilitation to help them walk again and countless other services they'd be entitled to under traditional Medicare.

What do the private policies specify? If treatment is authorized in the policy, then the insurance company is obligated to provide it. If they do not, they can be sued, which is a big difference between the private policy and the public option in Obamacare. I suspect too many people did not read their policies carefully. Also the government subsidized these 'private company' policies which may indicate how the so-called co-op option the Senate gang of 6 is working on would work (or not).

I wonder how many seniors really understand the difference between Medicare and Medicare Advantage. I have seen it too often with seniors, especially from folks ringing the doorbell and saying the roof is in serious need of repair, to calls from private healthcare providers demanding payment. At least my elderly mom, who has full insurance, has the wits to tell them it is their problem to call the insurer for payment, not hers.
Too many elderly get a bill and pay it immediately without question. I have always asked those in the 80s and 90s if they are going to finance a new house or car and need a good credit rating. If no, then why are they worrying about their credit rating and not taking time to investigate what the charge is for.

I have seen it too often with seniors, especially from folks ringing the doorbell and saying the roof is in serious need of repair, to calls from private healthcare providers demanding payment. At least my elderly mom, who has full insurance, has the wits to tell them it is their problem to call the insurer for payment, not hers.

Amen. And it is not just old folks. A lot of folks on the Gulf Coast were unaware that they were not insured against storm surges unless they had separate flood insurance. Katrina changed that. Katrina also proved that you have to be ready to fight the insurance companies too, but many people have been winning their cases. Health insurance is more complicated, I think, than storm and flood insurance, but the principles still apply: know what you are covered for, and be absolutely certain about exclusions in your policy.

I think people have to be knowledgeable about the insurance companies they deal with as well. A recent article in the local paper tried to make a case that there is not much competition in many parts of the country because often 1 or 2 companies dominate a market. They cited Blue Cross / Blue Shield as an example. Maybe that is because BC/BS has good reputation, not because of a lack of competition. My mother had BC/BS as her supplemental Medicare coverage for over 20 years, and never had a problem with them. Some of the companies mentioned in the above article on Medicare Advantage I have never heard of.

I think what really needs to be changed is the ability for an insurance customer to go outside the state to buy insurance. As a resident of NC, why can't I buy insurance from Vermont or Arkansas?
We also need to change the ER laws, not just not allowing them to buy insurance, as they will swarm ERs more than they already have. The same thing goes for Medicaid and all other public assistance they love so much.

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