Tag Archives: Medicare

Congresswoman Asks GAO To Investigate Medicare Advantage After Complaints

by

0

Congresswoman Rosa Delauro

Congresswoman Rosa Delauro

HAMDEN — About a dozen elderly people gathered in a conference room at Hamden Government Center on Friday to talk about their anger and frustration since UnitedHealthcare announced last fall it would cut thousands of doctors from its Medicare Advantage network.

They were further incensed when UnitedHealthcare and Yale-New Haven Health System did not reach a contract agreement, meaning the New Haven hospital will be dropped from the insurer’s Medicare Advantage network starting April 1.

Medicare Advantage is the version of government-funded Medicare that is offered by private insurers as an alternative, often with additional benefits and lower out-of-pocket expenses than traditional Medicare. The plans have been more expensive to federal taxpayers, on average, than traditional Medicare and the Affordable Care Act is scheduled to narrow the gap. As a result, insurers are offsetting the loss in government payments by changing benefits, premiums or physician networks.

The gathering was hosted by Congresswoman Rosa DeLauro, D-New Haven, who said she is asking the U.S. Government Accountability Office to investigate criteria for Medicare Advantage plans as set by the federal Centers for Medicare and Medicaid Services. DeLauro wanted to hear the experiences of people who have called her office to complain after UnitedHealthcare cut its Medicare Advantage physician network last fall.

The insurer has not said how many doctors it planned to eliminate, but the Fairfield County Medical Association has said it is 810 primary care physicians and 1,440 specialists across Connecticut.

“In light of the recent UnitedHealth Group network reductions, I am concerned that the oversight of Medicare Advantage plans may be lacking,” DeLauro wrote in a March 7 letter to Gene L. Dodaro, head of the GAO. UnitedHealth Group is the parent company of UnitedHealthcare.

She added that she is interested to learn how the Center for Medicare and Medicaid Services reviews whether seniors are receiving the quality care they deserve.

In addition to network cuts announced last fall, UnitedHealthcare and Yale-New Haven Health System failed to reach a contract agreement. As a result, the insurer said in February that Yale-New Haven will be cut from its Medicare Advantage network after March 31, with two exceptions. Bridgeport Hospital and Greenwich Hospital will remain in network. Other hospitals, such as Yale-New Haven and the Saint Raphael campus in New Haven, will be out of network starting April 1, and customers will face higher out-of-pocket expenses as a result.

“I’m 93. I don’t need this,” said Edwin R. Abrams, who was born in New Haven and has lived in the city his entire life except for three years in the Air Corps during World War II. He doesn’t want the hassle of going to Bridgeport Hospital instead of Yale-New Haven, which UnitedHealthcare suggests patients do.

Full Article & Source:
Congresswoman Asks GAO To Investigate Medicare Advantage After Complaints

Medicare Advantage plans to pay Central Ohio Primary Care to keep patients out of hospital

by

0

Advantage Plans title5The largest independent physician group in Central Ohio will get bonus payments for keeping the frailest patients well and out of the hospital under a new deal with five private Medicare Advantage plans.

Central Ohio Primary Care Physicians Inc. will get a fixed monthly payment for patients in the pilot program, plus a share of the savings from actuarial estimates of that group’s 2014 medical expenses. The plans also have agreed to pay for sending patients directly to a high-acuity wing of a skilled nursing facility without the usual requirement for a three-day hospital stay.

The average hospital stay costs at least $10,000, said Dr. William Wulf, CEO of the 270-doctor group. The practice’s hospitalists – specialists who follow patients through inpatient stays – say about one-fourth of patients admitted could have been cared for in a less-costly setting, but regulations and existing payment incentives encourage the hospitalization.

“What if that hospitalist was in a shared savings program for that $10,000?” Wulf said. “That’s where we need to go, that’s where we’re going with population health.”

Full Article & Source:
Medicare Advantage plans to pay Central Ohio Primary Care to keep patients out of hospital

Former Marine now battling Medicare for life-saving surgery

by

0

Robert Zurheide asking if they are waiting for him to dieTUCSON- A Tucson man and former Marine says his life is in limbo, caught between the need for life-saving surgery and a Medicare Advantage plan that will not cover the procedure. Robert Zurheide went on disability after he was injured in 2002 while working as a corrections officer in Florence. He has been battling chronic pancreatitis for nearly three years and says doctors at UAMC recommended a pancreas transplant as soon as possible. That was more than eight months ago.

“I love my country to the core, it’s in the core of me,” said Zurheide.

Military service is more than a passion for the Zurheide family, it is a way of life. Robert’s son Graham is a 1st Lieutenant in the Marines and his younger son has plans to join. However it is a tradition that claimed the life of Zurheide’s oldest son, 20-year-old Robert Zurheide Jr., who was killed while serving in Iraq in 2004.

“He came over, he gave me that big hug and he went back around to the car, got in and they drove off, and I never saw him again,” Zurheide said.

Nearly ten years after his son’s death, Zurheide says he is now fighting for his own life. He spends hours, even days in the hospital as his pancreas continues to fail.

“Worst pain I’ve ever felt in my life, and it could kill me,” he said.

Full Article, Video & Source:
Former Marine now battling Medicare for life-saving surgery

Not too late for certain Medicare beneficiaries to make changes

by

0

Although Medicare’s annual Open Enrollment period has ended, it’s not too late for certain Medicare beneficiaries to make changes for 2014.

Between Jan. 1 and Feb. 14 each year, people currently enrolled in a Medicare Advantage plan who wish to return to Original Medicare can disenroll from their Medicare Advantage plan, return to Original Medicare, and join a Part D drug plan. (In western Nevada County, the only Medicare Advantage Plan in 2014 is the AARP MedicareComplete SecureHorizons HMO.)

If beneficiaries who qualify for the Medicare Advantage Disenrollment Period decide to make this change, their new plan becomes effective the first day of the month following their enrollment request.

Anyone in need of assistance choosing a new plan for 2014 is welcome to make a free HICAP counseling appointment by calling the HelpLine office at 530-273-2273.

HICAP is a nonprofit organization that provides free, unbiased, one-on-one counseling to Medicare beneficiaries, including people who are new to Medicare.

Karin Hofland, Nevada County regional coordinator

HICAP Services of Northern California

Full Article & Source:
Not too late for certain Medicare beneficiaries to make changes

Minnesota attorney general asks U.S. to investigate Humana

by

0

Karen MerrickMinnesota Attorney General Lori Swanson said patients and doctors are having “significant problems” with Humana.

Minnesota Attorney General Lori Swanson is asking the federal government to investigate Humana’s Medicare Advantage policies after uncovering what she said were “significant problems” reported by Minnesota patients and medical providers.

Affidavits gathered from 25 Minnesotans showed a pattern where Humana denied claims for medical services required by law, overcharged for co-payments and coinsurance, and failed to disclose the providers that are in the network, she said. Swanson’s office also found that Humana didn’t follow procedures laid out by federal regulations for patients to appeal their cases.

“They were stringing people along, taking months to get back to people,” she said. “Oftentimes, it took the intervention of our office — and oftentimes we had to write multiple times.”

Humana, based in Louisville, Ky., is one of the nation’s largest health care insurers in Medicare Advantage, a private policy that covers seniors and those with disabilities. Humana has been doing business in Minnesota for more than 10 years, and provides insurance coverage to more than 100,000 residents through various types of Humana Medicare Advantage plans, including a plan for prescription drugs, according to a company official.

Humana spokeswoman Kate Marx said in an e-mail that the insurer has not been notified of the complaint by the Minnesota attorney general’s office or by federal regulators.

“We take this very seriously and are working to identify the facts,” Marx said.

 Full Article & Source:
Minnesota attorney general asks U.S. to investigate Humana

MN Attorney General Asks Feds To Investigate Humana

by

0

ST. PAUL, Minn. (WCCO) – Minnesota Attorney General Lori Swanson says a federal investigation is needed to look into business practices at one of the nation’s largest private Medicare insurers.

On Friday, Swanson sent a massive file of complaints against Humana to the federal agency charged with overseeing that part of Medicare.

She’s asking the Centers for Medicare & Medicaid Services (CMS) to look into more than 27 complaints on file.

For the past couple of years, Humana policy holders in Minnesota have complained of improper denial of coverage, overcharges for co-payments and failure to follow the required appeals process.

Kentucky-based Humana provides private Medicare insurance coverage to more than 100,000 Minnesota seniors.

This investigation into Humana’s alleged wrongdoing has been going on for a couple of years, Swanson asserts. It stems from both consumer and medical provider complaints from across the state.

Full Article & Source:
MN Attorney General Asks Feds To Investigate Humana