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Message 21 of 76

@somarco wrote:

@GailL1 for those who want more "inside baseball" about the Medicare payment system, this KFF article is written in mostly plain English.

https://www.kff.org/medicare/fact-sheet/medicare-advantage/

 

Probably more information than most people want or need  . . .

 

But the phone calls are about saving money.

 

Their (insurance carrier) money, not yours.


Yep, it is about the insurer's money - but if this program worked as designed for it's target purpose, it is suppose to save Medicare money too.  Shenanigans shouldn't play a part - not saying that there are shenanigans but it is hard to trust but verify the way it seems to be set up - seems the verification of the risk could be and should be more cut and dried.  

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Message 22 of 76

I think the calls are a good idea for people who don't maintain a good, regular relationship with a primary care physician.  For those of us who do, however, it's really annoying, and there should be a way we can opt out.

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Message 23 of 76

@GailL1 for those who want more "inside baseball" about the Medicare payment system, this KFF article is written in mostly plain English.

https://www.kff.org/medicare/fact-sheet/medicare-advantage/

 

Probably more information than most people want or need  . . .

 

But the phone calls are about saving money.

 

Their (insurance carrier) money, not yours.


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Message 24 of 76

@SharonB897005 what the heck is a "state" plan?


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Message 25 of 76

I am sure these health assessments by MA insurers could be very helpful, @SharonB897005 

 

However, let's not forget that MA providers get a bonus pay from Medicare if the beneficiary is rated at a higher risk.  The reasoning behind this (goal of risk payments) is that they want these insurers to keep these (perhaps sicker) folks under their care - Traditional Medicare doesn't want the "more" sick in their fold - and it actually penalizes the beneficiary because they probably can't get a reasinably priced supplemental plan by then either, if at all.  So Medicare pays a bonus to the insurer for treating these potentially "sicker" folks.

 

It all goes back to how the info is justifiably used and interpreted.  It should be a combination, not one or the other. (an "and" not an "or")

- to benefit the beneficiary

- to benefit the insurer's pocket

 

I am sure that that final decision is above your pay grade.  It happens with all the data combined - from doc, from health assessers, from test, from Dx codes -

 

But if the system of payment to insurers from Medicare were not so complicated and there were not so many special calls - perhaps it would be a little more forthcoming.  It is all for meeting the goal (as described above).

 

 

 

 

 

 

 

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Message 26 of 76

As a licensed agent for Medicare Advantage Insurance carriers, I work with clients that have chosen United Healthcare as their coverage.  If you have also done that you will periodically receive calls from a nurse to check with you about your health, to see how your chronic illnesses are such as diabetes or high blood pressure.  Also, once a year a housecalls provider will schedule an in home appointment to come out and do another annual assessment.  These have proven very helpful and, in some cases, have detected early colon cancer.    

So, when you get that annoying phone call asking about housecalls or for personal information make sure it's your insurance plan first. Then, if you are comfortable giving the information proceed. You do not have to participate in these programs. They are optional.

I always tell my clients that if they are happy with their current coverage,  just tell the person on the phone that or give them my number to contact. It doesn't always stop the calls. 

But, I have heard if you tell them you have "the state" plan, they will leave you alone.

 

Your NC Medicare Agent 

God bless!

 

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Message 27 of 76

As a licensed agent for Medicare Advantage Insurance carriers, I work with clients that have chosen United Healthcare as their coverage.  If you have also done that you will period receive calls from a nurse to check with you about your health, to see how your chronic illnesses are such as diabetes or high blood pressure.  Also, once a year a housecalls provider will schedule an in home appointment to come out and do another annual assessment.  These have proven very helpful and have detected in some cases early colon cancer and allowed treatment 

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Message 28 of 76

Removed reply to avoid possible retaliation.

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Message 29 of 76

@mc4039 UHC keeps calling me about these home visits. 

 

You probably have a managed care plan, HMO or PPO, but not original Medicare and a Medigap plan. In other words, an Advantage plan.

 

The home visit is to make sure you are doing what you need to maintain your health . . . and protect THEIR wallet.

 

It is only when you get sick(er) that THEY have to pony up serious money to  pay your claims.

 

Original Medicare allows you and your doctor to make decisions about your health care. No house calls. No follow up phone calls. They assume you are an adult and can take care of yourself.

 


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Message 30 of 76

The calls are coming from UNited Health Care

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