We Need a Law to Stop Insurance Companies from Giving Medical Advice

[aruzinsky]

Medical advice includes prescription reminders. 

I have an Aetna Medicare Advantage plan and Aetna insists on making robocalls to my answering machine and their machine pretends that my machine is a person.  Sometimes their machine starts talking before my answering machine goes beep.  So, what to do?  I have a device for blocking phone numbers and I block every robocall including Aetna's.  So, what does Aetna do?  It sent me this email:

So, I tell customer service to stop sending me harassing phone calls and emails or else I will complain to Medicare. To be continued.

[Roxanna35]

LOL  you can't win with any of them 

[GailL1]

@aruzinsky 

Well, I am not sure of the reason they are trying to contact you via phone or email unless you are getting all of your paperwork from them in electronic fashion and they are just using this as your contact method.  They should have your address too - so they can send you your paperwork and other notifications.

As to their responsibility of "Medical Advice" - it is limited to giving you information about changes - for safety, for cost, for (allowable) changes to your plan.  So actually, there is already a law (and rules) supporting some behavior of Medicare Part D Insurers.

Now IF this communication is more of a solicitation for [something] - there should be a way to "opt-out".

What's OK - in fact, what is necessary:

Within the Medicare Part D program is a stipulation that Med D Insurance Companies have the right and obligation to inform you of certain changes that may affect you.  This should be covered in your specific plan outline although all of them work under the guidelines issued by CMS. 

Some of these notices are for :

Maintenance Changes:  Intended to refine the safety of the Part D benefit, save taxpayer money and protect the interest of beneficiaries throughout the plan year. Maintenance changes include:

• removal (or change in tier placement) of a brand name drug based upon the addition of a new grade A generic at a lower cost to members;
• removal (or change in tier placement) of a formulary drug in light of new clinical evidence;
• adding new utilization management restriction(s) based on a new FDA "black box" warning;
• removal of a drug based on an FDA market withdrawal notice;
• removal of a non-Part D drug mistakenly included on the formulary.

Plans may notify members of maintenance changes at the same time that they submit the changes to CMS for approval.

Non-maintenance changes – Changes to formularies other than maintenance changes require the pre-approval of CMS. These changes can include changing the status of "preferred" vs. "non-preferred" drugs, adding utilization restrictions, or increasing cost sharing (for reasons other than those given for maintenance changes). After providing justification to and receiving approval from CMS, the plan is required to provide members with 60 days written advance notice. Further, members who are already taking the drug in question are exempt from the formulary change for the rest of the calendar year.

[aruzinsky]

---

@GailL1 wrote:

@aruzinsky 

As to their responsibility of "Medical Advice" - it is limited to giving you information about changes - for safety, for cost, for (allowable) changes to your plan.  So actually, there is already a law (and rules) supporting some behavior of Medicare Part D Insurers.

---

Oh, please!  My previous Advantage Plan insurer Cigna offered me $50 to take a special medical exam not endorsed by Medicare.  And they sent me an unsolicited test kit in the mail for prescreening colon cancer. 

[GailL1]

@aruzinsky 

That's not giving "medical advice" - that's just giving you an incentive to do something - much like some of the incentives given out by the government or some private companies to get people to get their covid vaccination.  

Medicare Advantage plans can offer other benefits over and above what Medicare offers.  Medicare has given them this right to keep you as healthy as they can cause that saves Medicare money.  In some care plans, they offer transportation to doctor appointments or pharmacy, sometimes food services, safety devices for the home that reduce the risk of injury and MORE . . . . 

KHN 04/03/2021 - Medicare Advantage Plans Cleared To Go Beyond Medical Coverage — Even Groceries 

Was the Cigna $50 for this?  They also incentivized your doctor too for this special type physical..

Cigna Health Springs - The 360 Physical Exam 

Just another offer from them for this special exam.  Same thing with sending you the self test kit for colon cancer - although that's part of the no out of pocket cost preventive care.

I replied to your post specifically under the way that Medicare Part D (prescription drug plan) works because the email copy that you posted says specifically "they want to talk to you about your medication treatment".  I gave you the reasons why they would be doing this per instructions from CMS -  these should be outlined in your plan.  It is part of Medicare Part D procedures.

There is NO Insurance company giving medical advice here. 

[aruzinsky]

Giving an incentive to do something medical is giving medical advice. And, whatever you want to call it, we need a law to stop it.  Or are you seriously going to contend that that is impossible because, in your opinion, there is no word for it?

[GailL1]

@aruzinsky 

No - I'm saying that it is designed this way for a purpose.  What you may not like, maybe very beneficial to others.  Might even save a life or two or at least help with their health and health care.

If you want to fight something - find out what Aetna is trying to communicate to you in regards to your medication treatment plan.  Then at least, you may have something to dispute or NOT.

[aruzinsky]

---

@GailL1 wrote:

@aruzinsky 

No - I'm saying that it is designed this way for a purpose.  What you may not like, maybe very beneficial to others.  Might even save a life or two or at least help with their health and health care.

---

I understand the purpose better than you.  Insurance companies want to improve the health of their AVERAGE members so they pay less in claims.  They do this while harming the health of those members who do not fit the medical profile of the AVERAGE member, i.e., are statistical outliers. This contrasts to medical doctors who take the Hippocratic Oath to do no harm.  Thus, Aetna's "your health is important to us" is a lie.

---

@GailL1 wrote:

@aruzinsky 

If you want to fight something - find out what Aetna is trying to communicate to you in regards to your medication treatment plan.  Then at least, you may have something to dispute or NOT.

---

Based on past experience, they want to tell me that their records indicate that I am not refilling my prescriptions and have a two way conversation about it ad nauseam.  They know that there is no reason to believe that their records are accurate.  For example, they have no way of knowing whether I purchased medication without insurance.  But, they feel entitled anyway.  This harassment has to stop.

And, if it isn't, it's still their fault for being the boy who cried wolf too often.

[aruzinsky]

---

@GailL1 wrote:

@aruzinsky 

Well, I am not sure of the reason they are trying to contact you via phone or email unless you are getting all of your paperwork from them in electronic fashion and they are just using this as your contact method. 

---

I gave you two very good hints why they are trying to contact me.

"Medical advice includes prescription reminders."

Guess again but don't be mislead by Aetna's lie of "important."  The messages are too frivolous to waste a postage stamp.

[somarco]

@aruzinsky Medicare has no control over how or how often Advantage plan carriers contact you. When you signed on for a managed care plan, whether you understood or not, you agreed to let the insurance carrier handle every aspect of your health care.

This is part of the price paid when you agree to let an insurance carrier manage your health care.

[aruzinsky]

---

@somarco wrote:

@aruzinsky Medicare has no control over how or how often Advantage plan carriers contact you.

---

Correct.  That is why I said, "We Need a Law".  Did you miss that?

Meanwhile, let me be the first person sued for breach of contract for blocking phone numbers and emails.  Ha, ha!