More spending isn't more care
01/02/23 01:30
According to the New York Times, the Biden administration announced a rule that cracks down on Medicare private plans that have overcharged the federal government. According to health and human services secretary Xavier Becerra, Medicare has been criticized for not taking a hard enough stand against Medicare Advantage plans that have a pattern of overcharging. I’m not expert in insurance, and I haven’t read the new rules, but it is my understanding that the insurers have been systematically overcharging the federal government by exaggerating the health problems of their customers to collect extra payments.
Like about half of Medicare patients, I am enrolled in a Medicare Advantage plan. I have never shopped for insurance, but have always been enrolled in the insurance programs of the United Church of Christ. This decision allowed us portability in our health care coverage. We could move to a new place and our coverage would continue uninterrupted. Upon our retirement, we continued with the church’s Medicare supplement program. That program is administered by a private insurance company under contract with the church. I don’t know anything about how that program bills the Federal Government, but I do know that it is continually trying to get me to over consume health care. Here are a few examples:
Our Medicare Advantage Plan has an online pharmacy. I purchase my prescription medicine through that pharmacy with small co-payments. It generally works well and is convenient for me. However, I have received dozens of messages from the online pharmacy urging me to renew prescriptions when I still have an adequate supply of medication. The plan tries hard to convince patients to enroll in auto-refills of medications. I tried that briefly and soon the amount of medication in my house was unnecessarily excessive. They would keep sending me medication even after I had a 120-day supply. They sent me medication in the week before my annual wellness examination with my doctor, in which medication might be changed. After having my physician cancel all of my prescriptions so that I could consume the excess medicine safely, I was able to get out of the automatic refill program. Still, I receive email and text messages urging me to refill prescriptions when I have one or two months’ supply on hand. When your insurance company is in the business of making profits for shareholders, one way for easy profits is to get patients to have excess medication on hand and bill the Federal Government for that extra medicine. Apply that technique over thousands of program participants and the company makes a lot more profits from selling medications, many of which are never consumed.
Since a few months into the Covid pandemic, our Medicare Advantage plan has offered free tele-medicine visits with company practitioners. Recently the program has contacted me repeatedly urging me to accept a “free remote wellness assessment.” Their promotions admit that the visit does not replace the annual Medicare wellness visit to my regular doctor. I’m always suspicious of the insurance company’s attempts at data mining, so I have simply refused to add that extra visit. I have a well-established relationship with my family physician and have no need for my insurance company to assign me another provider. In my opinion these “free remote wellness assessments” are not at all free, but rather another opportunity to bill the federal government for overconsumption of health care. I can see how other patients might not resist the constant high pressure marketing.
Recently the time came for me to have a colonoscopy. My family doctor advised me that there was a simple laboratory procedure by which I could avoid the invasive exam. I was also advised by my doctor not to submit a sample through the Medicare Advantage Plan’s program because the plan would not report the results to my doctor. I had the procedure done with the supplies provided by my doctor and submitted the sample to a local laboratory. However, my Medicare Advantage plan sent me another sample collecting kit and urged me to submit another sample to their laboratory. Had I done so the diagnostic procedure would have been conducted twice and the federal government would have been billed twice when only one procedure was needed. Even so, the extra sample kit was mailed to me and I am sure the government was billed for the unused kit.
One person’s experience, of course, is not the whole story. According to the New York Times article Medicare Advantage plans overfilled the government $479 million in overpayments from 2018 alone. That’s a lot of money.
50 years ago the federal government changed the rules governing health insurance providers. Prior to those changes all health insurance was provided by not-for-profit corporations. The introduction of profit into the health insurance business was touted as a way to drive down costs through competition. We now have 50 years of data on how this did not work. The costs of health care and of health insurance has skyrocketed in the US. We pay more than any other country for health care results that are worse than many other countries. Spend more and get less is not a way to save money. Investors want high profits. They favor increased income even if it means extracting money from the federal government.
Meanwhile politicians are eyeing Medicare expenditures as a way to cut the cost of government. Cutting the amount of money allocated to the program, however, may not get at the causes of overspending. Likely it will result in decreased care for those who need care.
It is a tough problem and I don’t know the solutions.
However, for now, I will continue to resist the attempts of my Medicare Advantage plan to get me to over consume health care. I’ve already blocked calls and texts from a dozen or more numbers, but they’re tricky and keep coming up with new ways to get their sales pitch to me. I wait until I need medicine to order medicine, and if I could I’d order my medicine in smaller quantities. It is unlikely that I will have any effect on my insurance company whatsoever. They probably don’t even know I’m resisting their marketing. Still, I did have a modest success the other day when a telemarketer for the insurance company did get through to me. I lectured the marketer on overconsumption and insurance company data mining until the marketer hung up on me. I took it as a small victory. The poor marketer saw it as a wasted effort.
Like about half of Medicare patients, I am enrolled in a Medicare Advantage plan. I have never shopped for insurance, but have always been enrolled in the insurance programs of the United Church of Christ. This decision allowed us portability in our health care coverage. We could move to a new place and our coverage would continue uninterrupted. Upon our retirement, we continued with the church’s Medicare supplement program. That program is administered by a private insurance company under contract with the church. I don’t know anything about how that program bills the Federal Government, but I do know that it is continually trying to get me to over consume health care. Here are a few examples:
Our Medicare Advantage Plan has an online pharmacy. I purchase my prescription medicine through that pharmacy with small co-payments. It generally works well and is convenient for me. However, I have received dozens of messages from the online pharmacy urging me to renew prescriptions when I still have an adequate supply of medication. The plan tries hard to convince patients to enroll in auto-refills of medications. I tried that briefly and soon the amount of medication in my house was unnecessarily excessive. They would keep sending me medication even after I had a 120-day supply. They sent me medication in the week before my annual wellness examination with my doctor, in which medication might be changed. After having my physician cancel all of my prescriptions so that I could consume the excess medicine safely, I was able to get out of the automatic refill program. Still, I receive email and text messages urging me to refill prescriptions when I have one or two months’ supply on hand. When your insurance company is in the business of making profits for shareholders, one way for easy profits is to get patients to have excess medication on hand and bill the Federal Government for that extra medicine. Apply that technique over thousands of program participants and the company makes a lot more profits from selling medications, many of which are never consumed.
Since a few months into the Covid pandemic, our Medicare Advantage plan has offered free tele-medicine visits with company practitioners. Recently the program has contacted me repeatedly urging me to accept a “free remote wellness assessment.” Their promotions admit that the visit does not replace the annual Medicare wellness visit to my regular doctor. I’m always suspicious of the insurance company’s attempts at data mining, so I have simply refused to add that extra visit. I have a well-established relationship with my family physician and have no need for my insurance company to assign me another provider. In my opinion these “free remote wellness assessments” are not at all free, but rather another opportunity to bill the federal government for overconsumption of health care. I can see how other patients might not resist the constant high pressure marketing.
Recently the time came for me to have a colonoscopy. My family doctor advised me that there was a simple laboratory procedure by which I could avoid the invasive exam. I was also advised by my doctor not to submit a sample through the Medicare Advantage Plan’s program because the plan would not report the results to my doctor. I had the procedure done with the supplies provided by my doctor and submitted the sample to a local laboratory. However, my Medicare Advantage plan sent me another sample collecting kit and urged me to submit another sample to their laboratory. Had I done so the diagnostic procedure would have been conducted twice and the federal government would have been billed twice when only one procedure was needed. Even so, the extra sample kit was mailed to me and I am sure the government was billed for the unused kit.
One person’s experience, of course, is not the whole story. According to the New York Times article Medicare Advantage plans overfilled the government $479 million in overpayments from 2018 alone. That’s a lot of money.
50 years ago the federal government changed the rules governing health insurance providers. Prior to those changes all health insurance was provided by not-for-profit corporations. The introduction of profit into the health insurance business was touted as a way to drive down costs through competition. We now have 50 years of data on how this did not work. The costs of health care and of health insurance has skyrocketed in the US. We pay more than any other country for health care results that are worse than many other countries. Spend more and get less is not a way to save money. Investors want high profits. They favor increased income even if it means extracting money from the federal government.
Meanwhile politicians are eyeing Medicare expenditures as a way to cut the cost of government. Cutting the amount of money allocated to the program, however, may not get at the causes of overspending. Likely it will result in decreased care for those who need care.
It is a tough problem and I don’t know the solutions.
However, for now, I will continue to resist the attempts of my Medicare Advantage plan to get me to over consume health care. I’ve already blocked calls and texts from a dozen or more numbers, but they’re tricky and keep coming up with new ways to get their sales pitch to me. I wait until I need medicine to order medicine, and if I could I’d order my medicine in smaller quantities. It is unlikely that I will have any effect on my insurance company whatsoever. They probably don’t even know I’m resisting their marketing. Still, I did have a modest success the other day when a telemarketer for the insurance company did get through to me. I lectured the marketer on overconsumption and insurance company data mining until the marketer hung up on me. I took it as a small victory. The poor marketer saw it as a wasted effort.
