We’ve been publishing numerous stories about how health insurers are refusing to pay for medically necessary care in both the private health plans they operate under the so-called Medicare Advantage name and in the health plans Americans buy on their own or through their employers.
The retired employees in the Ithaca City School District raised money to hire an attorney to persuade the school district to move us off of the forced Aetna Medicare Advantage insurance and give us the option we were using earlier, Medicare with a gap policy of Hartford Mutual.
Anne was it successful? The people that convinced Cortland created a consortium of upstate counties to do this by Doug Bulman of statewide Purchasing Alliance NY. They created the Brooke County Purchasing Alliance for this purpose
Retired employees of the Ithaca City School District were on Blue Cross/Blue Shield insurance with the school district paying as if the retired employees were still employed. That meant even though most were on Medicare the district was paying a lot of money to Blue Cross/Blue Shield. Through 3 or 4 public meetings retired employees were shown how this was an unnecessary expense. The district went with Traditional Medicare and gap insurance through Hartford Mutual. This arrangement worked.
Then without much, if any, notice we were switched to Aetna Medicare Advantage. For some this was OK and for others not. A group of retired employees (WHIR) formed to research, raise money, challenge the school board, and won the option to go back to Traditional Medicare/Hartford Mutual gap insurance. But only for those who had already turned 65, so newly retiring employees are stuck with Aetna Medicare Advantage. The group, WHIR, is now raising money to fight for future retirees.
Private insurance is BIG money and those corporations are not going to let it slip away. Brokers touting the MA programs make a profit from enrolling or keeping enrolled retirees. The broker the school district used appeared to be helping but really was not being honest when questioned. Here is an article on how much brokers can be paid.
Another financial fact I found out is the Hartford Mutual is a mutual corporation - no stockholders. State Farm Insurance is another huge mutual corporation - profits do not go to stockholders but back to policy holders. There are other mutual companies we don't seem to learn about.
Good! However, this is not a sustainable action. Congress needs to act now. MA overbills the government, i.e., your tax dollars by billions. Do a search. Easy to find stats.
oral surgeon here. I am in network with healthplex that recently was gobbled up by United Healthcare. Out of nowhere, they started rejected claims because they were not preauthorized. When we called to see when the policy changed and to find out what procedures need preauthorization, they were unable to tell us. We are in network and they cannot tell us what needs to be preauthorized and what does not. The information is not available in any paperwork or website to which we have access. We have spoke to numerous reps on the phone as well as to numerous people in administration and no one can tell us. So, we now have to preauthorize every single procedure to have any chance at being paid. And it leaves thousands of dollars of unpaid claims from before we realized they had changed the rules on preauth. This is the kind of stuff that pushes providers out of network (which makes one wonder if that is their goal as it reduces available providers thereby reducing services used and money paid out).
Seems like all of the orgs pushing for health care reform keep preaching to the choir getting little attention from the larger media. You and they really need an issue that shocks the system to focus on the racketeering aspects of health care. The shocking Oct 10, 2022 NYT article detailed the $25 billion + ANNUL fraud that Advantage plans are perpetrating upon Medicare but failed to lay blame where it deserves to be--with the Medicare trustees who are essentially colluding with the Advantage plans by failing to take action to stop the fraud. But no, they continue to do business with the fraudulent insurers. How can trustees not be liable for knowingly allowing fraud to prevail in their organization? So I suggest that a media campaign be waged accusing Janet Yellen, lead trustee, and the other trustees of malfeasance and complicity in the fraud. This could trash Yellen's reputation along with the other trustees and might shock them into action. The right action would be to ban the crooked insurers from doing business with Medicare for 5 to 10 years. This could deal a death blow to the big crooked insurers Advantage schemes. Of course the trustees are Presidential appointees and consequently doing the bidding of the President. Interesting where this powerful strategy might lead. Certainly not to the existing ho hum. Robert Messman, Denver, CO
Retired employees of the Ithaca City School District were on Blue Cross/Blue Shield insurance with the school district paying as if the retired employees were still employed. That meant even though most were on Medicare the district was paying a lot of money to Blue Cross/Blue Shield. Through 3 or 4 public meetings retired employees were shown how this was an unnecessary expense. The district went with Traditional Medicare and gap insurance through Hartford Mutual. This arrangement worked.
Then without much, if any, notice we were switched to Aetna Medicare Advantage. For some this was OK and for others not. A group of retired employees (WHIR) formed to research, raise money, challenge the school board, and won the option to go back to Traditional Medicare/Hartford Mutual gap insurance. But only for those who had already turned 65, so newly retiring employees are stuck with Aetna Medicare Advantage. The group, WHIR, is now raising money to fight for future retirees.
Private insurance is BIG money and those corporations are not going to let it slip away. Brokers touting the MA programs make a profit from enrolling or keeping enrolled retirees. The broker the school district used appeared to be helping but really was not being honest when questioned. Here is an article on how much brokers can be paid.
Another financial fact I found out is the Hartford Mutual is a mutual corporation - no stockholders. State Farm Insurance is another huge mutual corporation - profits do not go to stockholders but back to policy holders. There are other mutual companies we don't seem to learn about.
The retired employees in the Ithaca City School District raised money to hire an attorney to persuade the school district to move us off of the forced Aetna Medicare Advantage insurance and give us the option we were using earlier, Medicare with a gap policy of Hartford Mutual.
Anne was it successful? The people that convinced Cortland created a consortium of upstate counties to do this by Doug Bulman of statewide Purchasing Alliance NY. They created the Brooke County Purchasing Alliance for this purpose
Retired employees of the Ithaca City School District were on Blue Cross/Blue Shield insurance with the school district paying as if the retired employees were still employed. That meant even though most were on Medicare the district was paying a lot of money to Blue Cross/Blue Shield. Through 3 or 4 public meetings retired employees were shown how this was an unnecessary expense. The district went with Traditional Medicare and gap insurance through Hartford Mutual. This arrangement worked.
Then without much, if any, notice we were switched to Aetna Medicare Advantage. For some this was OK and for others not. A group of retired employees (WHIR) formed to research, raise money, challenge the school board, and won the option to go back to Traditional Medicare/Hartford Mutual gap insurance. But only for those who had already turned 65, so newly retiring employees are stuck with Aetna Medicare Advantage. The group, WHIR, is now raising money to fight for future retirees.
Private insurance is BIG money and those corporations are not going to let it slip away. Brokers touting the MA programs make a profit from enrolling or keeping enrolled retirees. The broker the school district used appeared to be helping but really was not being honest when questioned. Here is an article on how much brokers can be paid.
https://www.ritterim.com/blog/2024-maximum-broker-commissions-for-medicare-advantage-medicare-part-d/#agent-survival-kit
Another financial fact I found out is the Hartford Mutual is a mutual corporation - no stockholders. State Farm Insurance is another huge mutual corporation - profits do not go to stockholders but back to policy holders. There are other mutual companies we don't seem to learn about.
Here is the email for the Ithaca retired employees group - icsd-whir@googlegroups.com
Best, Anne Furman
Ann please email me retirees@nycretirees.org. We want to help
Good! However, this is not a sustainable action. Congress needs to act now. MA overbills the government, i.e., your tax dollars by billions. Do a search. Easy to find stats.
oral surgeon here. I am in network with healthplex that recently was gobbled up by United Healthcare. Out of nowhere, they started rejected claims because they were not preauthorized. When we called to see when the policy changed and to find out what procedures need preauthorization, they were unable to tell us. We are in network and they cannot tell us what needs to be preauthorized and what does not. The information is not available in any paperwork or website to which we have access. We have spoke to numerous reps on the phone as well as to numerous people in administration and no one can tell us. So, we now have to preauthorize every single procedure to have any chance at being paid. And it leaves thousands of dollars of unpaid claims from before we realized they had changed the rules on preauth. This is the kind of stuff that pushes providers out of network (which makes one wonder if that is their goal as it reduces available providers thereby reducing services used and money paid out).
Seems like all of the orgs pushing for health care reform keep preaching to the choir getting little attention from the larger media. You and they really need an issue that shocks the system to focus on the racketeering aspects of health care. The shocking Oct 10, 2022 NYT article detailed the $25 billion + ANNUL fraud that Advantage plans are perpetrating upon Medicare but failed to lay blame where it deserves to be--with the Medicare trustees who are essentially colluding with the Advantage plans by failing to take action to stop the fraud. But no, they continue to do business with the fraudulent insurers. How can trustees not be liable for knowingly allowing fraud to prevail in their organization? So I suggest that a media campaign be waged accusing Janet Yellen, lead trustee, and the other trustees of malfeasance and complicity in the fraud. This could trash Yellen's reputation along with the other trustees and might shock them into action. The right action would be to ban the crooked insurers from doing business with Medicare for 5 to 10 years. This could deal a death blow to the big crooked insurers Advantage schemes. Of course the trustees are Presidential appointees and consequently doing the bidding of the President. Interesting where this powerful strategy might lead. Certainly not to the existing ho hum. Robert Messman, Denver, CO
Retired employees of the Ithaca City School District were on Blue Cross/Blue Shield insurance with the school district paying as if the retired employees were still employed. That meant even though most were on Medicare the district was paying a lot of money to Blue Cross/Blue Shield. Through 3 or 4 public meetings retired employees were shown how this was an unnecessary expense. The district went with Traditional Medicare and gap insurance through Hartford Mutual. This arrangement worked.
Then without much, if any, notice we were switched to Aetna Medicare Advantage. For some this was OK and for others not. A group of retired employees (WHIR) formed to research, raise money, challenge the school board, and won the option to go back to Traditional Medicare/Hartford Mutual gap insurance. But only for those who had already turned 65, so newly retiring employees are stuck with Aetna Medicare Advantage. The group, WHIR, is now raising money to fight for future retirees.
Private insurance is BIG money and those corporations are not going to let it slip away. Brokers touting the MA programs make a profit from enrolling or keeping enrolled retirees. The broker the school district used appeared to be helping but really was not being honest when questioned. Here is an article on how much brokers can be paid.
https://www.ritterim.com/blog/2024-maximum-broker-commissions-for-medicare-advantage-medicare-part-d/#agent-survival-kit
Another financial fact I found out is the Hartford Mutual is a mutual corporation - no stockholders. State Farm Insurance is another huge mutual corporation - profits do not go to stockholders but back to policy holders. There are other mutual companies we don't seem to learn about.
Here is the email for the Ithaca retired employees group - icsd-whir@googlegroups.com
Best, Anne Furman