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United Healthcare and the Medicare Advantage scam; is this the tip of the iceberg?
If you have United Healthcare or Oxford Health Plans (purchased by United Healthcare a few years ago), you may have heard about the latest news on how United Health Group’s former finance director in Minneapolis, Benjamin Poehling, contends that his company and other insurers have been systematically bilking Medicare Advantage for years according to the NY Times.
When we look at healthcare costs, and how they have risen over the years, you must be asking yourself why, when other countries take care of their aging population at half the cost? Part of the problem is the predatory nature of private insurers who have forced health care providers and smaller hospitals to consider joining health care conglomerates such as the Barnabus system in NJ.
The large hospital systems and consolidation we see today is a direct result of the predatory behaviors of insurers toward health care facilities that had little ability to negotiate as a single entity. As the hospital systems grew, costs went up for insurers as well as you and I.
A recent example of this model is Horizon’s Omnia plan which you and I were told through their press releases reduces the cost of care. The smaller two-tiered network leaves out small hospitals and smaller providers who are not necessarily more expensive and may actually be of higher quality while making it more affordable to visit the larger hospital networks and their providers.
Omnia is resulting in the further consolidation of smaller hospitals as they join larger systems that are already in tier 1 and have lower copayments and better coverage, giving them an economic advantage. Smaller medical practices were given tier 2 which meant higher deductibles and co-payments and fewer patient visits. Many are also joining larger systems leaving us with more conglomerates, consolidation and higher prices. Chiropractors have been placed primarily in the higher-priced tier 2, even though data suggests they are more cost-effective, especially with the treatment of lower back pain, with only 6% having tier 1 status. There is currently a pending investigation regarding this tiered network and behind closed doors negotiations that led to it.
The current model of healthcare in N.J. is a lose-lose for patients and a system of medical rationing of healthcare that is uniquely American. Even when you do have the money, and can see who you want to see when you see them, it does not guarantee that your care is either effective or efficient. Insurance companies are likely making much more than they say they are, because you, the consumer has to pick up the first few thousands in doctor fees that are often negotiated poorly on your behalf.
Recently, United decided to pay chiropractors on a global fee basis including the initial time consuming first visit and x rays. As a patient, you have no idea they did this but when you find out your best doctors have dropped out, this was the reason. Other doctors in other specialties including primary care may have also dropped out of United, however, if you got your coverage through an employer, insurers activities over the years have forced everyone to pay more, while the system delivers less.
Where are the ethics in healthcare?
Recently, the NY Times reported that the U.S. Department of justice is suing United for their overcharging Medicare for their services related to Medicare Advantage plans, which offer Medicare recipients a replacement for Medicare. The plans offer a smaller network and supposedly more benefits until you decide to leave your state and find out that Medicare was a better value with a better network. Medicare Advantage plans are money makers for insurers such as United, and United exploited a loophole that is now being reported as fraud to improve their balance sheet at the patients’ expense. This was probably great for investors of United Healthcare, but lousy for the rest of us. Medicare, as offered by the government is by far the better value, with low deductibles and co-payments, and a 50 state network of doctors and hospitals. The plan is a cooperative between government and the private insurers who administrate the plan.
All roads lead to the inevitable idea of Medicare for all, which simplifies the system. Since Medicare is large, they have more negotiating clout with large monolithic hospital systems and the providers who are under their umbrella, which can reduce the overall cost of healthcare in our country.
Call your senator and congressman and demand they consider a true national healthcare plan, which will simplify costs, lower healthcare costs for all of us and offer cradle to grave coverage. True, it may eliminate the three employees your doctor has employed who are calling on denied claims, pre-certifications and the multiple drug formularies they need to employ before they call in your prescription. Doesn’t our healthcare system need to get back to the basics of taking care of all of us, and doing it well?
What do you think? There is a huge problem of ethics in the USA, from banking (Wells Fargo) to United Health Group. Politicians from both parties are taking money from the healthcare corporations which is the real reason we still have private insurers who can no longer control the healthcare cost monster they unleashed over the years. They could care less about us, as we saw with the current attempts at Trump Care.
Sign Bernie Sanders Petition for Medicare for all. If it is choice you want, smaller networks and higher costs and deductibles are the recipe for less choice, not more. The latest offerings from the Trump presidency is not a solution; since it is basically what we have now, with fewer rules and protections. Tell Washington you want single-payer Medicare for all.
The ethics problem with United Health Group will be aired in the press and will make great political theater. Wouldn’t it be refreshing is our government did something for us that would simplify insurance, lower the cost and help us stay healthy, while truly reducing the financial risk that can wipe out a lifetime of investing and saving?